Clinical Update on 10 Children Treated With Intralesional Cidofovir Injections for Severe Recurrent Respiratory Papillomatosis

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Abstract
RECURRENT RESPIRATORY papillomatosis (RRP) continues to be a problematic disease in regard to maintaining an adequate airway and preserving voice quality. Children with aggressive RRP, necessitating frequent surgical procedures, are at higher risk of airway compromise from their disease and iatrogenic morbidity from their treatment. In 1996, the use of intralesional injections of cidofovir, an acyclic nucleoside phosphonate, was initiated at our institution to treat children with severe RRP. The favorable clinical response to intralesional cidofovir injections in 5 children was described in a previous report by Pransky et al.1 To date, there are no long-term data concerning the efficacy of cidofovir in treating RRP or its potential complications. Herein, we report the extended clinical response to cidofovir of the original 5 patients and the current response to cidofovir of 5 new patients, in whom a revised protocol was used, all 10 of whom had severe RRP, requiring debulking at least once a month. We also describe the histopathologic findings in biopsy specimens of laryngeal tissue obtained more than 1 year after the patients underwent repeated cidofovir injections and propose guidelines for future studies of the use of cidofovir.