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Review
. 2014 Dec;34(6):375-81.

Recurrent respiratory papillomatosis by HPV: review of the literature and update on the use of cidofovir

M Fusconi  1 , M Grasso  1 , A Greco  1 , A Gallo  2 , F Campo  1 , M Remacle  3 , R Turchetta  1 , G Pagliuca  2 , M DE Vincentiis  1
Affiliations
Review

Recurrent respiratory papillomatosis by HPV: review of the literature and update on the use of cidofovir

M Fusconi et al. Acta Otorhinolaryngol Ital. 2014 Dec.

Abstract
in English, Italian

Recurrent respiratory papillomatosis is a viral induced disease characterised by exophytic epithelial lesions affecting the larynx. The problem with its treatment is the high recurrence of papilloma growth after surgical removal. The aim of our review is to analyse the actual use of cidofovir, an agent used in adjuvant therapy. We have reviewed 6 manuscripts that included a total of 118 patients. The parameters taken into account were: concentration of infiltrated cidofovir (mg/ml), therapeutic response, relapse-free time (months), side effects, genotypes (HPV-6/11/18) and evolution of dysplasia. Cidofovir was injected at concentrations from 2.5 to 15 mg/ml, therapeutic response was from 56.25% to 82.3% and relapse-free time was from 10.05 to 49 months. There were 2 cases of dysplasia during therapy. Ten patients had been infected by HPV-6, 4 patients by HPV-11 and 10 patients by HPV-6 and HPV-11. The purposes of our review include the following: to stress that the juvenile form is more aggressive than other forms, to demonstrate than the drug has good adjuvant action although it does not significantly change the final response to the disease, to show that side effects are modest and, finally, to disprove the hypothesis that cidofovir may promote evolution towards dysplasia. In conclusion, combination of surgical removal and injection of cidofovir is associated with good response in recurrent respiratory papillomatosis.

La papillomatosi respiratoria ricorrente è una malattia di origine virale caratterizzata da lesione esofitiche della laringe. Il problema del trattamento è l'alta frequenza con cui si riforma la lesione dopo l'asportazione chirurgica. Lo scopo della nostra review è valutare l'efficacia del cidofovir attualmente utilizzato come terapia adiuvante. Abbiamo analizzato 6 manoscritti, per un totale 118 pazienti. Sono stati considerati i seguenti parametri di valutazione: concentrazione cidofovir infiltrato (mg/ml); risposta terapeutica; tempo libero da ricadute (mesi); effetti indesiderati; genotipo (HPV-16,-18/HPV-6,-11) e evoluzione displasia. L'infiltrazione del cidofovir è variata da 2,5 mg/ml a 15 mg/ml, con una risposta terapeutica tra il 56,25% e l'82,3% e un tempo libero da ricadute dai 10,05 ai 49 mesi. In corso di terapia si sono avuti due casi di displasia. 10 pazienti erano stati infettati da HPV-6, 4 da HPV-11, 10 da entrambi i genotipi HPV-6 e 11. Dai nostri dati è emersa la conferma che la forma giovanile è maggiormente aggressiva, il farmaco ha una buona azione adiuvante ma non incide in modo significativo sulla risposta finale alla malattia, modesti sono gli effetti collaterali ed infine si smentisce l'ipotesi che il cidofovir possa favorire l'evoluzione verso la displasia. In conclusione la combinazione dell'ablazione chirurgica e cidofovir ha una buona azione adiuvante nella papillomatosi respiratoria ricorrente.

Keywords: Cidofovir; Larynx; Recurrent respiratory papillomatosis.

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Figures

Fig. 1.
Fig. 1.
Correlation between relapse-free time and dose of cidofovir.
Fig. 2.
Fig. 2.
Correlation between dose of cidofovir and complete response.
See this image and copyright information in PMC

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