Craig S Derkay1,2,3, Andrew E Bluher1,4. 1. Department of Otolaryngology - Head and Neck Surgery. 2. Pediatric Otolaryngology, Eastern Virginia Medical School. 3. Children's Hospital of the King's Daughters. 4. Eastern Virginia Medical School, Sentara Norfolk General Hospital, Norfolk, Virginia, USA.
Abstract
PURPOSE OF REVIEW: Recurrent respiratory papillomatosis (RRP) is the most common as well as the costliest benign airway neoplasm in the United States [Ivancic et al. (2018). Laryngoscope Investig Otolaryngol 3:22; Derkay (1995). Arch Otolaryngol Head Neck Surg 121:1386]. In addition, it is potentially deadly, with risk of airway obstruction as well as a 3-7% risk of malignant conversion [Schraff et al. (2004). Arch Otolaryngol Head Neck Surg 130:1039]. This review highlights exciting advancements over the past 1-2 years in scientific understanding of the pathophysiology, epidemiology, natural history, prevention, and treatment of this difficult disease. RECENT FINDINGS: Recent studies have yielded the following findings: The primary quality of life reduction that patients perceive is voice-related; the membranous vocal folds are the most frequently involved anatomic subsite in adult-onset RRP; there may be a correlation between laryngopharyngeal reflux, herpes simplex virus type 2, and adult-onset RRP; there has been a decline in RRP incidence in Australia following the implementation of a national vaccination program; addition of educational audiovisual aids assists in vaccine acceptance rates; preventive vaccination can be used as treatment for pediatric as well as adult RRP patients with demonstrable effects on antibody titers and reoperation rates; calreticulin-linked DNA vaccines show promise in reducing the growth rate of human papilloma virus (HPV)11 E6/E7-expressing tumors in mice; injection of bevacizumab is associated with no adverse tissue affects; systemic bevacizumab is effective as a treatment for severe uncontrolled disease; pegylated interferon treatment is effective in select severe pediatric RRP disease; and finally, increased rates of programed death 1 T-lymphocyte infiltration and programed death-ligand 1 expression are seen on both papilloma and infiltrating immune cells. SUMMARY: RRP is declining in incidence but remains a challenging disease to treat with great costs to patients, families, and the healthcare system. As the disease continues to be better understood, new frontiers are opening in treatment, particularly for severe or poorly controlled disease. Until the disease can be eradicated, it remains a vital area of research to help prevent new cases and treat afflicted patients.
PURPOSE OF REVIEW: Recurrent respiratory papillomatosis (RRP) is the most common as well as the costliest benign airway neoplasm in the United States [Ivancic et al. (2018). Laryngoscope Investig Otolaryngol 3:22; Derkay (1995). Arch Otolaryngol Head Neck Surg 121:1386]. In addition, it is potentially deadly, with risk of airway obstruction as well as a 3-7% risk of malignant conversion [Schraff et al. (2004). Arch Otolaryngol Head Neck Surg 130:1039]. This review highlights exciting advancements over the past 1-2 years in scientific understanding of the pathophysiology, epidemiology, natural history, prevention, and treatment of this difficult disease. RECENT FINDINGS: Recent studies have yielded the following findings: The primary quality of life reduction that patients perceive is voice-related; the membranous vocal folds are the most frequently involved anatomic subsite in adult-onset RRP; there may be a correlation between laryngopharyngeal reflux, herpes simplex virus type 2, and adult-onset RRP; there has been a decline in RRP incidence in Australia following the implementation of a national vaccination program; addition of educational audiovisual aids assists in vaccine acceptance rates; preventive vaccination can be used as treatment for pediatric as well as adult RRP patients with demonstrable effects on antibody titers and reoperation rates; calreticulin-linked DNA vaccines show promise in reducing the growth rate of human papilloma virus (HPV)11 E6/E7-expressing tumors in mice; injection of bevacizumab is associated with no adverse tissue affects; systemic bevacizumab is effective as a treatment for severe uncontrolled disease; pegylated interferon treatment is effective in select severe pediatric RRP disease; and finally, increased rates of programed death 1 T-lymphocyte infiltration and programed death-ligand 1 expression are seen on both papilloma and infiltrating immune cells. SUMMARY: RRP is declining in incidence but remains a challenging disease to treat with great costs to patients, families, and the healthcare system. As the disease continues to be better understood, new frontiers are opening in treatment, particularly for severe or poorly controlled disease. Until the disease can be eradicated, it remains a vital area of research to help prevent new cases and treat afflicted patients.
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Authors: Douglas R Sidell; Karthik Balakrishnan; Simon R Best; Karen Zur; Julia Buckingham; Alessandro De Alarcon; Fuad M Baroody; Jonathan M Bock; Emily F Boss; Charles M Bower; Paolo Campisi; Sharon F Chen; Jeffrey M Clarke; Kevin D Clarke; Alejandro Cocciaglia; Robin T Cotton; Giselle Cuestas; Kara L Davis; Victor H DeFago; Frederik G Dikkers; Ines Dossans; Walter Florez; Elizabeth Fox; Aaron D Friedman; Nazaneen Grant; Osama Hamdi; Norman D Hogikyan; Kaalan Johnson; Liane B Johnson; Romaine F Johnson; Peggy Kelly; Adam M Klein; Claire M Lawlor; Nicolas Leboulanger; Alejandro G Levy; Derek Lam; Greg R Licameli; Steve Long; David G Lott; Dayse Manrique; James Scott McMurray; Kara D Meister; Anna H Messner; Michael Mohr; Pamela Mudd; Anthony J Mortelliti; Daniel Novakovic; Julian Ongkasuwan; Shazia Peer; Krysztof Piersiala; Jeremy D Prager; Seth M Pransky; Diego Preciado; Tiffany Raynor; Rico N P M Rinkel; Hugo Rodriguez; Verónica P Rodríguez; John Russell; María Laura Scatolini; Patrick Scheffler; David F Smith; Lee P Smith; Marshall E Smith; Richard J H Smith; Abraham Sorom; Amalia Steinberg; John A Stith; Dana Thompson; Jerome W Thompson; Patricio Varela; David R White; Andre M Wineland; Christina J Yang; Carlton J Zdanski; Craig S Derkay Journal: Laryngoscope Date: 2021-01-06 Impact factor: 2.970