RRP (RECURRENT RESPIRATORY PAPILLOMATOSIS)
PRIMARILY HPV 6 & 11 (RARELY TYPE 16 & 18)
HIGH CORRELATION WITH MATERNAL HPV (CONTROVERSIAL TO CONSIDER C-SECTION)
MAY PROGRESS TO SCCA—SEEM THIS
REQUIRE MULTIPLE SURGERIES—CO2 VS PIPE—-BEST ITITIAL THERAPY IS CO2 LASER RESECTION? Microdebrider may actually give better voice outcomes
ADJUNCTIVE THERAPY REMAINS UNPROVEN—-Acylcovir, MTX, RIBAVARIN, MUMPS (Mumps Vaccine), PPI, Alpha Interferon, Hsp E7, RETINOIDS(retinoic acid)—-RT?
TRACH —-AVOID IT IF YOU CAN TO AVOID DISTAL SEEDING
NEW DATA SEEMS EXCITING WITH INTRALESIONAL CIDOPIVIR/CIDOFOVIR–DONE THIS WITH GOOD RESULTS WITH 27 GUAGE NEEDLE. Off label, but seems to reduce the frequency of surgeries.
Adjuvant therapies. Use the CO2 laser. Have patients eat green leafy vegetables (Indole-3-carbinols) modulates estrogen metabolism and 1/3 of patients respond. Inject Cidofovir after resection. Place on Celebrex (Cox 2 inhibitor) modulates the over expression of epidermal growth factor by inhibiting cyclooxygenase-2 and prostaglandin E2. Give Gardisil (6,11,16,18). Consider injecting Avastin (Bevacizumab) recombinant monoclonal antibody against vascular endothelial growth factor.