Voice-preserving Treatment of Larynegeal Papilloma

描述(申请人提供)：呼吸道复发性乳头状瘤(RRP)是儿童最常见的良性肿瘤。这种疾病通常累及声带或喉部的其他部位，从而导致嗓音不佳。手术切除是目前治疗RRP的方法，但这是一种非常创伤性的手术。这种手术经常会造成声带疤痕，并导致永久性的发声功能障碍。我们以前的研究表明，使用585 nm脉冲染料激光(PDL)的微血管靶向技术(MVT)治疗RRP是有效和安全的。这项技术提供了一种创伤较小的手术替代方法。然而，由于微血管的再生，术后病变的复发仍然是一个问题。这项研究是我们努力开发一种新的、创伤较小的RRP治疗方法的继续。在这项研究中，我们将开发一种新的、结合PDL和塞来昔布的RRP治疗方法。我们将确定新近开发的环氧合酶(COX)-2抑制剂塞来昔布是否通过其抗血管生成活性和激光治疗产生的协同效应对RRP起到长期抑制作用。假设术后应用塞来昔布对微血管再生和COX-2酶有长期的抑制作用，从而防止PDL治疗后RRP复发。我们在这项研究中的具体目的是确定PDL和塞来昔布的协同作用以及塞来昔布预防术后RRP复发的长期疗效。我们将在30例成人患者中将这种新的联合治疗策略与传统的CO2激光治疗进行比较。这是首次将这种新的激光MVT技术与COX-2抑制剂联合用于RRP的微血管靶向治疗。如果在这项拟议的研究中取得成功，这种联合策略将为RRP提供一种新的、理想的“保声”疗法，在管理RRP方面将提供长期有效的效果，并将足够安全和方便地用于门诊治疗。

DESCRIPTION (provided by applicant): Respiratory recurrent papilloma (RRP) is the most common benign tumor occurring in children. This disease usually involves the vocal cords or other regions of the larynx, thereby, resulting in a poor voice. Surgical removal is the current management for RRP, but it is a very traumatic procedure. The surgery often produces vocal cord scarring and leads to permanent voice dysfunction. Our previous studies have shown the efficacy and safety of a microvascular targeting technique (MVT) for RRP treatment using the 585 nm pulsed dye laser (PDL). This technique provides a less traumatic alternative to surgery. However, postoperative recurrence of lesions still remains a problem because of microvascular regrowth. This study is a continuation of our effort to develop a new and less traumatic treatment for RRP. In this study, we will develop a new, combined RRP treatment with PDL and Celecoxib. We will determine if Celecoxib, a newly developed inhibitor of cyclooxygenase (COX)-2, can provide a long-term inhibitory effect on RRP through its anti-angiogenic activity and the synergic effect produced with the laser therapy. The hypothesis is that postoperative administration of Celecoxib will provide a long-term inhibitory effect on microvascular regrowth and on COX-2 enzyme, thereby, preventing RRP from recurring after the PDL therapy. Our specific aim in this study is to determine the synergic effect between PDL and Celecoxib and long-term efficacy of Celecoxib in preventing postoperative RRP recurrence. We will compare this new combined strategy with traditional CO2 laser treatment in 30 adult patients. This is the first time to combined this new laser MVT technique with a COX-2 inhibitor for microvascular targeting therapy of RRP. This combined strategy, if successful in this proposed study, will provide a new and ideal "voice-preserving" therapy for RRP that will deliver long-term efficacy in managing RRP and will be safe and convenient enough for use in out-patient treatment.