Clinical update on 10 children treated with intralesional cidofovir injections for severe recurrent respiratory papillomatosis.
Clinical update on 10 children treated with intralesional cidofovir injections for severe recurrent respiratory papillomatosis.
复制标题
10 例病灶内注射西多福韦治疗严重复发性呼吸道乳头状瘤儿童的临床更新。
DOI：
10.1001/archotol.126.10.1239
复制
发表时间：
2000
期刊：
影响因子：
--
通讯作者：
Donald B. Kearns
中科院分区：
文献类型：
--
作者：
S. Pransky;Douglas F. Brewster;A. Magit;Donald B. Kearns
目标
继续评估病灶内给予西多福韦（一种无环核苷膦酸盐）治疗儿科患者严重复发性呼吸道乳头状瘤病（RRP）的益处和风险，并讨论使用西多福韦的更大规模前瞻性多机构研究的指南。
设计
前瞻性案例系列。
设置
三级甲等儿童医院。
患者
总共 10 名患有严重 RRP（定义为每月至少一次需要减瘤手术以维持气道通畅）的患者接受了病灶内西多福韦治疗。最初的 5 名患者自上次注射西多福韦以来已接受了超过 1 年的随访，随后的 5 名患者接受了修订后的注射方案治疗。
干预
重复二氧化碳激光治疗和乳头状瘤机械减灭后，进行微悬浮喉镜检查，病灶内注射西多福韦。
主要成果指标
系列喉镜检查时的乳头状瘤阶段。对上次注射西多福韦后 1 年或更长时间获得的喉组织活检标本进行组织学检查。
结果
有证据表明，根据修订后的注射方案入组的 5 名新患者中，有 4 名病情显着改善，原 5 名患者中的 1 名继续无病状态，5 名原患者中的 4 名持续改善，导致干预间隔时间显着缩短。
结论
病灶内西多福韦治疗在治疗儿科患者的严重 RRP 方面继续显示出益处。安全性尚未完全确定，但目前的组织学数据令人放心。
OBJECTIVES
To continue assessment of the benefits and risks of intralesional administration of cidofovir, an acyclic nucleoside phosphonate, for treating severe recurrent respiratory papillomatosis (RRP) in pediatric patients, and to discuss guidelines for larger prospective multi-institutional studies of the use of cidofovir.
DESIGN
Prospective case series.
SETTING
Tertiary care children's hospital.
PATIENTS
A total of 10 patients with severe RRP (defined as requiring debulking procedures to maintain airway patency at least once a month) underwent intralesional cidofovir therapy. The original 5 patients have received more than 1 year of follow-up since their last cidofovir injection, and 5 subsequent patients have been treated with a revised injection protocol.
INTERVENTION
Microsuspension laryngoscopy with intralesional injection of cidofovir after repetitive carbon dioxide laser treatments and mechanical debulking of papillomas.
MAIN OUTCOME MEASURES
Papilloma stage at the time of serial laryngoscopies. Histologic examination of biopsy specimens of laryngeal tissue obtained 1 year or more after last cidofovir injection.
RESULTS
There was evidence of marked improvement in the 4 of the 5 new patients enrolled under the revised injection protocol, continuation of a disease-free state in 1 of the original 5 patients, and sustained improvement in 4 of the 5 original patients, resulting in a significantly reduced interval of intervention.
CONCLUSIONS
Intralesional cidofovir therapy continues to show benefit in the treatment of severe RRP in pediatric patients. Safety profiles have not been fully established, but current histologic data are reassuring.