Intralesional cidofovir in severe juvenile respiratory papillomatosis

Intralesional cidofovir in severe juvenile respiratory papillomatosis. Recurrent respiratory papillomatosis causes significant morbidity among affected children and usually requires frequent surgeries. We present a prospective case series including nine children at a Mexican tertiary referral center. All enrolled patients had severe disease that had required at least four surgical procedures, with a median of 6. Two children had tracheobronchial involvement, one had lung parenchymal disease, and one had a tracheostomy performed during his first surgery. Objective: To assess the efficacy of intralesional cidofovir in lowering the surgery rate. Study Design: Prospective case series. Setting: Tertiary referral center in Mexico City. Methods: Nine Mexican children with severe disease were enrolled. Intralesional cidofovir was applied after surgical debulking at a concentration of 5mg/mL with a four to six week interval. Results: Six of the nine patients had a notable decrease in the rate of surgeries, with three patients remaining diseasefree with follow up ranging from 1.8 to 3.3 years. No patient demonstrated laboratory abnormalities. Two patients showed moderate and mild dysplasia on papilloma biopsy distinguished by a lack of epithelial maturation with no mitoses or cellular atypia. Two patients died several months after the last injection. Conclusions: Intralesional cidofovir appears to be effective in the treatment of recurrent respiratory papillomatosis, although further studies are required to determine its safety.