Topical Chemotherapy of Recurrent Respiratory Papillomatosis

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Abstract
Topical chemotherapy with the antimetabolite 5-fluorouracil (5-FU) has been used as an adjunct to surgical laser excision of squamous papillomas arising in the larynx and in the tracheobronchial tree. The drug has been administered intensively to eight patients with tracheotomies and disease in both anatomic regions. These patients received repeated instillations of 5-FU at concentrations from 0.5 to 5% into the larynx and tracheobronchial tree while in the hospital and at home. More than 4,500 doses of the drug have been administered during our phase 1 study. There has been no significant toxicity associated with repeated 5-FU instillation into the airway. Several patients developed blood-tinged tracheal secretions after the repeated use of high concentrations of the agent. Other complications included coughing, bronchospasm, and peristomal irritation. These symptoms all disappeared after temporary discontinuation of the drug. No patient has developed a systemic hypersensitivity response to the drug either detectable clinically or by repeated skin testing. There were no adverse effects on the hematologic or hepatic systems. Use of 5-FU was associated with inhibition of papilloma regrowth in six of eight patients. The major limitation to drug effectiveness is the requirement for its frequent administration.

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