Treatment of Childhood Laryngeal Papillomatosis

A single-institution retrospective analysis evaluated 121 children with respiratory papillomatosis. The age at initial operation was 4.3 years (±2.9 years), and 47.9% of patients (58 of 121) experienced a recurrence and underwent surgical treatment after the age of 14 years.[10]

A single-institution retrospective analysis evaluated 121 children with respiratory papillomatosis. The age at initial operation was 4.3 years (±2.9 years), and 47.9% of patients (58 of 121) experienced a recurrence and underwent surgical treatment after the age of 14 years.[10]

At follow-up, 5% of the patients (6 of 121) had died, 41.3% of the patients (50 of 121) had been recurrence free for 5 years or longer (cured group), and 53.7% of the patients (65 of 121) experienced a recurrence in the previous 5 years (recurrent group).

A single-institution retrospective analysis evaluated 121 children with respiratory papillomatosis. The age at initial operation was 4.3 years (±2.9 years), and 47.9% of patients (58 of 121) experienced a recurrence and underwent surgical treatment after the age of 14 years.[10]

There were no significant differences in sex, age at initial operation, or adjuvant therapy between the cured and recurrent groups of patients.

A single-institution retrospective analysis evaluated 121 children with respiratory papillomatosis. The age at initial operation was 4.3 years (±2.9 years), and 47.9% of patients (58 of 121) experienced a recurrence and underwent surgical treatment after the age of 14 years.[10]

In the recurrent group, there was a higher incidence of overall operation frequency, aggressive disease, tracheal dissemination of the papilloma, and HPV infection.

Systemic bevacizumab produced good results with minimal toxicity in a report of two patients with aggressive recurrent respiratory papillomatosis.[11] In another report of seven children treated with bevacizumab, continued responses were noted and subsequent surgical debridements were avoided in most patients. Of the seven patients, five did not require surgical debridement after the initiation of bevacizumab. Four of these five patients had previously required between four and ten debridements per year. Follow-up for these patients was between 8 months and 3.5 years. No serious adverse events were reported.[12] In a study of 24 patients with recurrent respiratory papillomatosis, 15 had juvenile-onset disease. Patients were treated with systemic bevacizumab (7.5–10 mg/kg) every 3 to 4 weeks. All patients had a reduction in the number and size of lesions after three doses, excluding one patient who was lost to follow-up. Voice outcomes were improved in 87.5% of patients, as measured by Voice Handicap Index-30 (VHI) or pediatric VHI. No grade 3 Common Terminology Criteria for Adverse Events were reported. However, follow-up was limited to a maximum of 14 months after initiation of therapy and 10 months after discontinuation of bevacizumab.[13] In a study of 17 adult patients (12 with juvenile-onset recurrent or refractory respiratory papillomatosis) who received systemic bevacizumab, the number of recurrences and surgeries were significantly reduced compared with previous treatments.[14]

Interferon therapy.[15]

Immunotherapy with HspE7, a recombinant fusion protein that has shown activity in other HPV-related diseases. A pilot study suggested a marked increase in the amount of time between surgeries.[16]

Laser therapy combined with intralesional bevacizumab.[17]

Intralesional cidofovir has been studied. However, its effectiveness has not been conclusively demonstrated.[18]

Checkpoint inhibitors, such as PD-1 inhibitors, are currently being investigated.[19]

Reports with small numbers of patients have documented that in selected cases, the administration of a quadrivalent HPV vaccine was associated with complete remission and an increase in the intersurgical interval.[20,21] In contrast, other reports have not documented a therapeutic effect of the quadrivalent HPV vaccine.[22]