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Louw Feenstra - One of the best experts on this subject based on the ideXlab platform.
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Treatment of Severe Laryngeal Papillomatosis With Intralesional Injections of Cidofovir
2016Co-Authors: Erik De Clercq, Louw FeenstraAbstract:Respiratory Papillomatosis is a rare and often severe disease, usually localized in the larynx. It may cause respiratory distress and even life-threatening obstruction of the airways. Treat-ment is generally based on the evaporation of the lesions with a CO2 laser, but microsurgery, cytotoxic and/or cytostatic drugs, interferons, and vaccines are also used. Cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine] (HPMPC) was shown to suppress the growth of tumors induced by rabbit papillomavirus as well as human papillomavirus (HPV). The efficacy of cidofovir was assessed in 17 patients with se-vere respiratory Papillomatosis. Cidofovir at a concentration of 2.5 mg/ml was injected directly in the different laryngeal papillomatous lesions during microlaryngoscopy under general anes-thesia. Biopsies were taken before the treatment was started both for anatomopathology and vi-ral typing. HPMPC kinetics in serum was moni-tored in three patients, the drug levels being de-termined by high-performance liquid chroma-tography. Complete disappearance of the Papillomatosis was observed in 14 patients. Four patients relapsed and were successfully treated again with cidofovir. Of the three remain-ing patients, one progressed while under treat-ment with cidofovir, after an initial marked re-sponse. One patient had a partial remission and remained stable for more than 1 year after the last injection. He had a very aggressive and ex-tensive disease originally. Finally, one patient was lost to follow-up after four injections. Intra-tumoral injections of cidofovir for the treatment of severe laryngeal Papillomatosis is a powerful new therapeutic approach for this disease. Treatment was well tolerated, and no significant side effects were noted. J. Med. Virol. 54:219
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Systemic Cidofovir in Papillomatosis
2016Co-Authors: Isabelle Van Valckenborgh, Robert Snoeck, Willy Wellens, Erik De Clercq, Louw Feenstra, Kris De Boeck, Otorhinolaryngology Department, Universitaire Ziekenhuizen, St. RafaeèlAbstract:An 8-year-old patient with severe recurrent respiratory papil-lomatosis and pulmonary spread was treated by systemic administration of cidofovir in association with laser treat-ment for tracheal lesions. Complete disappearance of the lesions in the pharynx and larynx and a signi®cant yet in-complete regression in the bronchi and lung parenchyma were observed without deleterious side effects. This is the ®rst case report of systemic use of cidofovir to treat recurrent respiratory Papillomatosis. Since the ®rst description of laryngeal Papillomatosis in 1871, it has been recognized as the most common benign neoplasm of the larynx and the most common tumor of the upper res-piratory tract in children [1]. In the United States, 1500 new cases are diagnosed every year. Now called recurrent respiratory Papillomatosis (RRP), it has a tendency to relapse and is seen in both children and adults [2]. The incidence is highest before the age of 5 years. Histologically benign, it may be a serious clinical problem because of its location, resistance to therapy, recurrences, occasional spread into the lower respiratory tract, and malignant transformation into squamous cell carcinoma. RRP is caused mainly by the human papillomaviruses HPV-6 and HPV-11 [2]. The standard treatment is palliative removal of the papillomas by CO2 laser to allow for both airway and voice improvement [3]. Numerous other forms of medical and surgical treatment have been used with varying success [4, 5]. This report concerns an 8-year-old Chinese girl with RRP of the pharynx, larynx, trachea, and lungs. There is currently no established therapy for RRP with pulmonary spread. We treate
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treatment of severe laryngeal Papillomatosis with intralesional injections of cidofovir s 1 3 hydroxy 2 phosphonylmethoxypropyl cytosine
Journal of Medical Virology, 1998Co-Authors: Robert Snoeck, Willy Wellens, Christian Desloovere, Mark Van Ranst, Lieve Naesens, Erik De Clercq, Louw FeenstraAbstract:Respiratory Papillomatosis is a rare and often severe disease, usually localized in the larynx. It may cause respiratory distress and even life-threatening obstruction of the airways. Treatment is generally based on the evaporation of the lesions with a CO2 laser, but microsurgery, cytotoxic and/or cytostatic drugs, interferons, and vaccines are also used. Cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine] (HPMPC) was shown to suppress the growth of tumors induced by rabbit papillomavirus as well as human papillomavirus (HPV). The efficacy of cidofovir was assessed in 17 patients with severe respiratory Papillomatosis. Cidofovir at a concentration of 2.5 mg/ml was injected directly in the different laryngeal papillomatous lesions during microlaryngoscopy under general anesthesia. Biopsies were taken before the treatment was started both for anatomopathology and viral typing. HPMPC kinetics in serum was monitored in three patients, the drug levels being determined by high-performance liquid chromatography. Complete disappearance of the Papillomatosis was observed in 14 patients. Four patients relapsed and were successfully treated again with cidofovir. Of the three remaining patients, one progressed while under treatment with cidofovir, after an initial marked response. One patient had a partial remission and remained stable for more than 1 year after the last injection. He had a very aggressive and extensive disease originally. Finally, one patient was lost to follow-up after four injections. Intratumoral injections of cidofovir for the treatment of severe laryngeal Papillomatosis is a powerful new therapeutic approach for this disease. Treatment was well tolerated, and no significant side effects were noted.
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treatment of severe laryngeal Papillomatosis with intralesional injections of cidofovir s 1 3 hydroxy 2 phosphonylmethoxypropyl cytosine
Journal of Medical Virology, 1998Co-Authors: Robert Snoeck, Willy Wellens, Christian Desloovere, Lieve Naesens, Erik De Clercq, Mark Van Ranst, Louw FeenstraAbstract:Respiratory Papillomatosis is a rare and often severe disease, usually localized in the larynx. It may cause respiratory distress and even life-threatening obstruction of the airways. Treatment is generally based on the evaporation of the lesions with a CO2 laser, but microsurgery, cytotoxic and/or cytostatic drugs, interferons, and vaccines are also used. Cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine] (HPMPC) was shown to suppress the growth of tumors induced by rabbit papillomavirus as well as human papillomavirus (HPV). The efficacy of cidofovir was assessed in 17 patients with severe respiratory Papillomatosis. Cidofovir at a concentration of 2.5 mg/ml was injected directly in the different laryngeal papillomatous lesions during microlaryngoscopy under general anesthesia. Biopsies were taken before the treatment was started both for anatomopathology and viral typing. HPMPC kinetics in serum was monitored in three patients, the drug levels being determined by high-performance liquid chromatography. Complete disappearance of the Papillomatosis was observed in 14 patients. Four patients relapsed and were successfully treated again with cidofovir. Of the three remaining patients, one progressed while under treatment with cidofovir, after an initial marked response. One patient had a partial remission and remained stable for more than 1 year after the last injection. He had a very aggressive and extensive disease originally. Finally, one patient was lost to follow-up after four injections. Intratumoral injections of cidofovir for the treatment of severe laryngeal Papillomatosis is a powerful new therapeutic approach for this disease. Treatment was well tolerated, and no significant side effects were noted. J. Med. Virol. 54:219– 225, 1998. © 1998 Wiley-Liss, Inc.
Steven M Zeitels - One of the best experts on this subject based on the ideXlab platform.
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high dose sublesional bevacizumab avastin for pediatric recurrent respiratory Papillomatosis
Annals of Otology Rhinology and Laryngology, 2014Co-Authors: Douglas R Sidell, Steven M Zeitels, Michel Nassar, Robin T Cotton, Alessandro De AlarconAbstract:Objectives:We review and report the use of high-dose bevacizumab for the treatment of recurrent respiratory Papillomatosis (RRP) in pediatric patients.Methods:We included all patients with pediatri...
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safety and dosing of bevacizumab avastin for the treatment of recurrent respiratory Papillomatosis
Annals of Otology Rhinology and Laryngology, 2012Co-Authors: Simon R Best, James A Burns, Robert E Hillman, Anca M Barbu, Tali Landauzemer, Aaron D Friedman, Mason W Freeman, Yuan Di C Halvorsen, Steven M ZeitelsAbstract:Objectives:Increasing evidence supports the use of laryngeal injections of the antiangiogenic agent bevacizumab (Avastin) for the adjuvant treatment of recurrent respiratory Papillomatosis (RRP). A...
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local injection of bevacizumab avastin and angiolytic ktp laser treatment of recurrent respiratory Papillomatosis of the vocal folds a prospective study
Annals of Otology Rhinology and Laryngology, 2011Co-Authors: Steven M Zeitels, James A Burns, Gerardo Lopezguerra, Anca M Barbu, Tali Landauzemer, Aaron D Friedman, Mason W Freeman, Yuandi C Halvorsen, Robert E HillmanAbstract:Objectives:Photoangiolytic laser treatment of recurrent respiratory Papillomatosis (RRP) is effective, but does not reliably prevent recurrence. Therefore, sublesional injections of the antiangioge...
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microlaryngoscopic and office based injection of bevacizumab avastin to enhance 532 nm pulsed ktp laser treatment of glottal Papillomatosis
The Annals of otology rhinology & laryngology. Supplement, 2009Co-Authors: Steven M Zeitels, James A Burns, Gerardo Lopezguerra, Matthew J Lutch, Aaron M Friedman, Robert E HillmanAbstract:Objectives:Photoangiolytic lasers effectively treat glottal Papillomatosis, but do not reliably prevent recurrence. Therefore, sublesional injections of the antiangiogenic agent bevacizumab (Avasti...
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microflap laryngosplasty for treating an anterior commissure web with Papillomatosis
Laryngoscope, 2007Co-Authors: Lee M Akst, Matthew S Broadhurst, James A Burns, Steven M ZeitelsAbstract:INTRODUCTION Based on postmortem examinations of the larynx and trachea, recurrent respiratory Papillomatosis (RRP) was well described as a cause of death from airway obstruction in the early 19th century.1 Laryngeal RRP has been an omnipresent surgical problem in Laryngology2since the origin of the specialty 150 years ago. Laryngeal Papillomatosis has had a predilection for glottal membranes and it has always been commonplace to identify disease in the anterior commissure. Resection of laryngeal Papillomatosis was an office-based mirror-guided procedure in the 19th century and became a direct laryngoscopic method3 that migrated to the operating room4 with systemic anesthesia in the 20th century.5 Although magnification provided by the microscope6,7 and hemostatic cutting/ablation characteristics of the CO2 laser enhance precision,8–10 anterior-commissure scarring and synechia (web) commonly occur in association with any form of surgical treatment. When papillomatous epithelium recurs in a surgically induced anterior-commissure web, further treatment becomes increasingly more difficult and more morbid. There are two key indications to treat an anteriorcommissure web associated with Papillomatosis. First, it is essential to expand the glottal aperture in those patients with restricted airways. Second, it is important to expose Papillomatosis on the undersurface of the web and in the subglottis. (Fig. 1A, B) In our practice, exposure of the anterior subcordal and subglottal regions is now of greater consequence. This is because we now manage the majority of our Papillomatosis patients as an office-based procedure through a flexible laryngoscope5,11 and substantive intraprocedural retraction is not currently practical with this treatment paradigm. Although reducing papillomatous epithelium overlying a web will typically enhance vocal function, we do not generally treat limited webs for pure phonatory indications. This is because vocal function is unlikely to improve if there is not pliable superficial lamina propria (SLP) underlying the epithelium. Therefore, we treat an anterior glottal web surgically when it significantly impacts our ability to treat the patient’s papilloma, or if the web itself is large enough to substantively restrict the airway. Treating anterior-commissure glottal webs can be done through open neck surgery or microlaryngoscopic mucosal flaps. Transcervical laryngofissure techniques often used for treating nonPapillomatosis webs are generally discouraged with RRP. Microlaryngoscopic mucosal advancement-rotation flaps were described many years ago and are most successful in congenital webs. Typically, there is subepithelial pliable SLP, which allows for stretching and advancing the epithelial flap anteriorly. Mucosal advancement flaps are far less successful when there is normal epithelium adherent to fibrotic scar. Despite dividing the web and borrowing epithelium from one side, the mucosal advancement-rotation flap cannot usually be affixed to its optimal position anteriorly. Moreover, suturing the flap anteriorly is technically very difficult if one is working at the perimeter of the laryngoscope speculum.12,13 We therefore instituted a novel technique for endoscopic laryngoplasty in patients with RRP overlying an anterior-commissure web.
James A Burns - One of the best experts on this subject based on the ideXlab platform.
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safety and dosing of bevacizumab avastin for the treatment of recurrent respiratory Papillomatosis
Annals of Otology Rhinology and Laryngology, 2012Co-Authors: Simon R Best, James A Burns, Robert E Hillman, Anca M Barbu, Tali Landauzemer, Aaron D Friedman, Mason W Freeman, Yuan Di C Halvorsen, Steven M ZeitelsAbstract:Objectives:Increasing evidence supports the use of laryngeal injections of the antiangiogenic agent bevacizumab (Avastin) for the adjuvant treatment of recurrent respiratory Papillomatosis (RRP). A...
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local injection of bevacizumab avastin and angiolytic ktp laser treatment of recurrent respiratory Papillomatosis of the vocal folds a prospective study
Annals of Otology Rhinology and Laryngology, 2011Co-Authors: Steven M Zeitels, James A Burns, Gerardo Lopezguerra, Anca M Barbu, Tali Landauzemer, Aaron D Friedman, Mason W Freeman, Yuandi C Halvorsen, Robert E HillmanAbstract:Objectives:Photoangiolytic laser treatment of recurrent respiratory Papillomatosis (RRP) is effective, but does not reliably prevent recurrence. Therefore, sublesional injections of the antiangioge...
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microlaryngoscopic and office based injection of bevacizumab avastin to enhance 532 nm pulsed ktp laser treatment of glottal Papillomatosis
The Annals of otology rhinology & laryngology. Supplement, 2009Co-Authors: Steven M Zeitels, James A Burns, Gerardo Lopezguerra, Matthew J Lutch, Aaron M Friedman, Robert E HillmanAbstract:Objectives:Photoangiolytic lasers effectively treat glottal Papillomatosis, but do not reliably prevent recurrence. Therefore, sublesional injections of the antiangiogenic agent bevacizumab (Avasti...
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microflap laryngosplasty for treating an anterior commissure web with Papillomatosis
Laryngoscope, 2007Co-Authors: Lee M Akst, Matthew S Broadhurst, James A Burns, Steven M ZeitelsAbstract:INTRODUCTION Based on postmortem examinations of the larynx and trachea, recurrent respiratory Papillomatosis (RRP) was well described as a cause of death from airway obstruction in the early 19th century.1 Laryngeal RRP has been an omnipresent surgical problem in Laryngology2since the origin of the specialty 150 years ago. Laryngeal Papillomatosis has had a predilection for glottal membranes and it has always been commonplace to identify disease in the anterior commissure. Resection of laryngeal Papillomatosis was an office-based mirror-guided procedure in the 19th century and became a direct laryngoscopic method3 that migrated to the operating room4 with systemic anesthesia in the 20th century.5 Although magnification provided by the microscope6,7 and hemostatic cutting/ablation characteristics of the CO2 laser enhance precision,8–10 anterior-commissure scarring and synechia (web) commonly occur in association with any form of surgical treatment. When papillomatous epithelium recurs in a surgically induced anterior-commissure web, further treatment becomes increasingly more difficult and more morbid. There are two key indications to treat an anteriorcommissure web associated with Papillomatosis. First, it is essential to expand the glottal aperture in those patients with restricted airways. Second, it is important to expose Papillomatosis on the undersurface of the web and in the subglottis. (Fig. 1A, B) In our practice, exposure of the anterior subcordal and subglottal regions is now of greater consequence. This is because we now manage the majority of our Papillomatosis patients as an office-based procedure through a flexible laryngoscope5,11 and substantive intraprocedural retraction is not currently practical with this treatment paradigm. Although reducing papillomatous epithelium overlying a web will typically enhance vocal function, we do not generally treat limited webs for pure phonatory indications. This is because vocal function is unlikely to improve if there is not pliable superficial lamina propria (SLP) underlying the epithelium. Therefore, we treat an anterior glottal web surgically when it significantly impacts our ability to treat the patient’s papilloma, or if the web itself is large enough to substantively restrict the airway. Treating anterior-commissure glottal webs can be done through open neck surgery or microlaryngoscopic mucosal flaps. Transcervical laryngofissure techniques often used for treating nonPapillomatosis webs are generally discouraged with RRP. Microlaryngoscopic mucosal advancement-rotation flaps were described many years ago and are most successful in congenital webs. Typically, there is subepithelial pliable SLP, which allows for stretching and advancing the epithelial flap anteriorly. Mucosal advancement flaps are far less successful when there is normal epithelium adherent to fibrotic scar. Despite dividing the web and borrowing epithelium from one side, the mucosal advancement-rotation flap cannot usually be affixed to its optimal position anteriorly. Moreover, suturing the flap anteriorly is technically very difficult if one is working at the perimeter of the laryngoscope speculum.12,13 We therefore instituted a novel technique for endoscopic laryngoplasty in patients with RRP overlying an anterior-commissure web.
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532 nm pulsed potassium titanyl phosphate laser treatment of laryngeal Papillomatosis under general anesthesia
Laryngoscope, 2007Co-Authors: James A Burns, Matthew S Broadhurst, Steven M Zeitels, Lee M Akst, Robert E Hillman, Rox AndersonAbstract:Objectives: Angiolytic lasers have been shown to be an effective treatment strategy for laryngeal Papillomatosis. These lasers precisely target hemoglobin within the microcirculation of papillary lesions. We have previously demonstrated the advantages of the fiber-based pulsed 532-nm potassium-titanyl-phosphate (KTP) laser in an office setting (with local anesthesia). This investigation provides the first report of the pulsed-KTP laser during microlaryngoscopy under general anesthesia. Study Design: A prospective pilot study was performed in 55 adult patients with laryngeal Papillomatosis to determine disease response. Methods: During suspension microlaryngoscopy, a solid-state 532 nm pulsed-KTP laser was used (15 ms pulse width, 5.25–7.5 J/pulse maximum output, 2 Hz repetition rate, 0.4 mm fiber, approximately 20–80 J/cm2 fluence) to treat laryngeal Papillomatosis. All patients underwent postoperative videolaryngoscopy to assess disease regression based on a previously used rating scale. Results: Thirty-seven patients underwent 55 procedures during the 18-month study period. Near-term follow-up with an early postoperative evaluation was available in 23 patients (35 procedures). Fourteen patients (20 procedures) were geographically distant and only returned after developing symptoms with significant disease recurrence. Of the 35 procedures in which near-term follow-up was available, 90% or greater disease regression was achieved in 28 of 35 (80%), 75% to 89% disease regression was achieved in 4 of 35 (11%), and 50% to 74% disease regression in 3 of 35 (9%). Anterior-commissure disease was present in 51 of 55 (93%) cases, and no new webbing/synechia occurred. All patients reported that their vocal function improved after treatment. Conclusions: The 532 nm pulsed-KTP laser was effective for treating recurrent respiratory Papillomatosis, which was similar to our experience as an office-based procedure.
Robert Snoeck - One of the best experts on this subject based on the ideXlab platform.
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Systemic Cidofovir in Papillomatosis
2016Co-Authors: Isabelle Van Valckenborgh, Robert Snoeck, Willy Wellens, Erik De Clercq, Louw Feenstra, Kris De Boeck, Otorhinolaryngology Department, Universitaire Ziekenhuizen, St. RafaeèlAbstract:An 8-year-old patient with severe recurrent respiratory papil-lomatosis and pulmonary spread was treated by systemic administration of cidofovir in association with laser treat-ment for tracheal lesions. Complete disappearance of the lesions in the pharynx and larynx and a signi®cant yet in-complete regression in the bronchi and lung parenchyma were observed without deleterious side effects. This is the ®rst case report of systemic use of cidofovir to treat recurrent respiratory Papillomatosis. Since the ®rst description of laryngeal Papillomatosis in 1871, it has been recognized as the most common benign neoplasm of the larynx and the most common tumor of the upper res-piratory tract in children [1]. In the United States, 1500 new cases are diagnosed every year. Now called recurrent respiratory Papillomatosis (RRP), it has a tendency to relapse and is seen in both children and adults [2]. The incidence is highest before the age of 5 years. Histologically benign, it may be a serious clinical problem because of its location, resistance to therapy, recurrences, occasional spread into the lower respiratory tract, and malignant transformation into squamous cell carcinoma. RRP is caused mainly by the human papillomaviruses HPV-6 and HPV-11 [2]. The standard treatment is palliative removal of the papillomas by CO2 laser to allow for both airway and voice improvement [3]. Numerous other forms of medical and surgical treatment have been used with varying success [4, 5]. This report concerns an 8-year-old Chinese girl with RRP of the pharynx, larynx, trachea, and lungs. There is currently no established therapy for RRP with pulmonary spread. We treate
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treatment of severe laryngeal Papillomatosis with intralesional injections of cidofovir s 1 3 hydroxy 2 phosphonylmethoxypropyl cytosine
Journal of Medical Virology, 1998Co-Authors: Robert Snoeck, Willy Wellens, Christian Desloovere, Mark Van Ranst, Lieve Naesens, Erik De Clercq, Louw FeenstraAbstract:Respiratory Papillomatosis is a rare and often severe disease, usually localized in the larynx. It may cause respiratory distress and even life-threatening obstruction of the airways. Treatment is generally based on the evaporation of the lesions with a CO2 laser, but microsurgery, cytotoxic and/or cytostatic drugs, interferons, and vaccines are also used. Cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine] (HPMPC) was shown to suppress the growth of tumors induced by rabbit papillomavirus as well as human papillomavirus (HPV). The efficacy of cidofovir was assessed in 17 patients with severe respiratory Papillomatosis. Cidofovir at a concentration of 2.5 mg/ml was injected directly in the different laryngeal papillomatous lesions during microlaryngoscopy under general anesthesia. Biopsies were taken before the treatment was started both for anatomopathology and viral typing. HPMPC kinetics in serum was monitored in three patients, the drug levels being determined by high-performance liquid chromatography. Complete disappearance of the Papillomatosis was observed in 14 patients. Four patients relapsed and were successfully treated again with cidofovir. Of the three remaining patients, one progressed while under treatment with cidofovir, after an initial marked response. One patient had a partial remission and remained stable for more than 1 year after the last injection. He had a very aggressive and extensive disease originally. Finally, one patient was lost to follow-up after four injections. Intratumoral injections of cidofovir for the treatment of severe laryngeal Papillomatosis is a powerful new therapeutic approach for this disease. Treatment was well tolerated, and no significant side effects were noted.
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treatment of severe laryngeal Papillomatosis with intralesional injections of cidofovir s 1 3 hydroxy 2 phosphonylmethoxypropyl cytosine
Journal of Medical Virology, 1998Co-Authors: Robert Snoeck, Willy Wellens, Christian Desloovere, Lieve Naesens, Erik De Clercq, Mark Van Ranst, Louw FeenstraAbstract:Respiratory Papillomatosis is a rare and often severe disease, usually localized in the larynx. It may cause respiratory distress and even life-threatening obstruction of the airways. Treatment is generally based on the evaporation of the lesions with a CO2 laser, but microsurgery, cytotoxic and/or cytostatic drugs, interferons, and vaccines are also used. Cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine] (HPMPC) was shown to suppress the growth of tumors induced by rabbit papillomavirus as well as human papillomavirus (HPV). The efficacy of cidofovir was assessed in 17 patients with severe respiratory Papillomatosis. Cidofovir at a concentration of 2.5 mg/ml was injected directly in the different laryngeal papillomatous lesions during microlaryngoscopy under general anesthesia. Biopsies were taken before the treatment was started both for anatomopathology and viral typing. HPMPC kinetics in serum was monitored in three patients, the drug levels being determined by high-performance liquid chromatography. Complete disappearance of the Papillomatosis was observed in 14 patients. Four patients relapsed and were successfully treated again with cidofovir. Of the three remaining patients, one progressed while under treatment with cidofovir, after an initial marked response. One patient had a partial remission and remained stable for more than 1 year after the last injection. He had a very aggressive and extensive disease originally. Finally, one patient was lost to follow-up after four injections. Intratumoral injections of cidofovir for the treatment of severe laryngeal Papillomatosis is a powerful new therapeutic approach for this disease. Treatment was well tolerated, and no significant side effects were noted. J. Med. Virol. 54:219– 225, 1998. © 1998 Wiley-Liss, Inc.
Erik De Clercq - One of the best experts on this subject based on the ideXlab platform.
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Treatment of Severe Laryngeal Papillomatosis With Intralesional Injections of Cidofovir
2016Co-Authors: Erik De Clercq, Louw FeenstraAbstract:Respiratory Papillomatosis is a rare and often severe disease, usually localized in the larynx. It may cause respiratory distress and even life-threatening obstruction of the airways. Treat-ment is generally based on the evaporation of the lesions with a CO2 laser, but microsurgery, cytotoxic and/or cytostatic drugs, interferons, and vaccines are also used. Cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine] (HPMPC) was shown to suppress the growth of tumors induced by rabbit papillomavirus as well as human papillomavirus (HPV). The efficacy of cidofovir was assessed in 17 patients with se-vere respiratory Papillomatosis. Cidofovir at a concentration of 2.5 mg/ml was injected directly in the different laryngeal papillomatous lesions during microlaryngoscopy under general anes-thesia. Biopsies were taken before the treatment was started both for anatomopathology and vi-ral typing. HPMPC kinetics in serum was moni-tored in three patients, the drug levels being de-termined by high-performance liquid chroma-tography. Complete disappearance of the Papillomatosis was observed in 14 patients. Four patients relapsed and were successfully treated again with cidofovir. Of the three remain-ing patients, one progressed while under treat-ment with cidofovir, after an initial marked re-sponse. One patient had a partial remission and remained stable for more than 1 year after the last injection. He had a very aggressive and ex-tensive disease originally. Finally, one patient was lost to follow-up after four injections. Intra-tumoral injections of cidofovir for the treatment of severe laryngeal Papillomatosis is a powerful new therapeutic approach for this disease. Treatment was well tolerated, and no significant side effects were noted. J. Med. Virol. 54:219
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Systemic Cidofovir in Papillomatosis
2016Co-Authors: Isabelle Van Valckenborgh, Robert Snoeck, Willy Wellens, Erik De Clercq, Louw Feenstra, Kris De Boeck, Otorhinolaryngology Department, Universitaire Ziekenhuizen, St. RafaeèlAbstract:An 8-year-old patient with severe recurrent respiratory papil-lomatosis and pulmonary spread was treated by systemic administration of cidofovir in association with laser treat-ment for tracheal lesions. Complete disappearance of the lesions in the pharynx and larynx and a signi®cant yet in-complete regression in the bronchi and lung parenchyma were observed without deleterious side effects. This is the ®rst case report of systemic use of cidofovir to treat recurrent respiratory Papillomatosis. Since the ®rst description of laryngeal Papillomatosis in 1871, it has been recognized as the most common benign neoplasm of the larynx and the most common tumor of the upper res-piratory tract in children [1]. In the United States, 1500 new cases are diagnosed every year. Now called recurrent respiratory Papillomatosis (RRP), it has a tendency to relapse and is seen in both children and adults [2]. The incidence is highest before the age of 5 years. Histologically benign, it may be a serious clinical problem because of its location, resistance to therapy, recurrences, occasional spread into the lower respiratory tract, and malignant transformation into squamous cell carcinoma. RRP is caused mainly by the human papillomaviruses HPV-6 and HPV-11 [2]. The standard treatment is palliative removal of the papillomas by CO2 laser to allow for both airway and voice improvement [3]. Numerous other forms of medical and surgical treatment have been used with varying success [4, 5]. This report concerns an 8-year-old Chinese girl with RRP of the pharynx, larynx, trachea, and lungs. There is currently no established therapy for RRP with pulmonary spread. We treate
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treatment of severe laryngeal Papillomatosis with intralesional injections of cidofovir s 1 3 hydroxy 2 phosphonylmethoxypropyl cytosine
Journal of Medical Virology, 1998Co-Authors: Robert Snoeck, Willy Wellens, Christian Desloovere, Mark Van Ranst, Lieve Naesens, Erik De Clercq, Louw FeenstraAbstract:Respiratory Papillomatosis is a rare and often severe disease, usually localized in the larynx. It may cause respiratory distress and even life-threatening obstruction of the airways. Treatment is generally based on the evaporation of the lesions with a CO2 laser, but microsurgery, cytotoxic and/or cytostatic drugs, interferons, and vaccines are also used. Cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine] (HPMPC) was shown to suppress the growth of tumors induced by rabbit papillomavirus as well as human papillomavirus (HPV). The efficacy of cidofovir was assessed in 17 patients with severe respiratory Papillomatosis. Cidofovir at a concentration of 2.5 mg/ml was injected directly in the different laryngeal papillomatous lesions during microlaryngoscopy under general anesthesia. Biopsies were taken before the treatment was started both for anatomopathology and viral typing. HPMPC kinetics in serum was monitored in three patients, the drug levels being determined by high-performance liquid chromatography. Complete disappearance of the Papillomatosis was observed in 14 patients. Four patients relapsed and were successfully treated again with cidofovir. Of the three remaining patients, one progressed while under treatment with cidofovir, after an initial marked response. One patient had a partial remission and remained stable for more than 1 year after the last injection. He had a very aggressive and extensive disease originally. Finally, one patient was lost to follow-up after four injections. Intratumoral injections of cidofovir for the treatment of severe laryngeal Papillomatosis is a powerful new therapeutic approach for this disease. Treatment was well tolerated, and no significant side effects were noted.
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treatment of severe laryngeal Papillomatosis with intralesional injections of cidofovir s 1 3 hydroxy 2 phosphonylmethoxypropyl cytosine
Journal of Medical Virology, 1998Co-Authors: Robert Snoeck, Willy Wellens, Christian Desloovere, Lieve Naesens, Erik De Clercq, Mark Van Ranst, Louw FeenstraAbstract:Respiratory Papillomatosis is a rare and often severe disease, usually localized in the larynx. It may cause respiratory distress and even life-threatening obstruction of the airways. Treatment is generally based on the evaporation of the lesions with a CO2 laser, but microsurgery, cytotoxic and/or cytostatic drugs, interferons, and vaccines are also used. Cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine] (HPMPC) was shown to suppress the growth of tumors induced by rabbit papillomavirus as well as human papillomavirus (HPV). The efficacy of cidofovir was assessed in 17 patients with severe respiratory Papillomatosis. Cidofovir at a concentration of 2.5 mg/ml was injected directly in the different laryngeal papillomatous lesions during microlaryngoscopy under general anesthesia. Biopsies were taken before the treatment was started both for anatomopathology and viral typing. HPMPC kinetics in serum was monitored in three patients, the drug levels being determined by high-performance liquid chromatography. Complete disappearance of the Papillomatosis was observed in 14 patients. Four patients relapsed and were successfully treated again with cidofovir. Of the three remaining patients, one progressed while under treatment with cidofovir, after an initial marked response. One patient had a partial remission and remained stable for more than 1 year after the last injection. He had a very aggressive and extensive disease originally. Finally, one patient was lost to follow-up after four injections. Intratumoral injections of cidofovir for the treatment of severe laryngeal Papillomatosis is a powerful new therapeutic approach for this disease. Treatment was well tolerated, and no significant side effects were noted. J. Med. Virol. 54:219– 225, 1998. © 1998 Wiley-Liss, Inc.
