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的其他部位，从而导致声音不佳。手术切除是目前治疗RRP的方法，但这是一个非常创伤性的过程。手术通常会造成声带瘢痕，并导致永久性的声音功能障碍。我们之前的研究表明，微血管靶向技术（MVT）使用585 nm脉冲染料激光（PDL）治疗RRP的有效性和安全性。这项技术为外科手术提供了一种创伤较小的选择。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性更小的RRP治疗方法的延续。在这项研究中，我们将开发一种新的RRP与PDL和塞来昔布联合治疗。我们将确定新开发的环氧化酶(COX)-2抑制剂塞来昔布是否可以通过其抗血管生成活性和与激光治疗产生的协同效应对RRP提供长期抑制作用。假设术后给予塞来昔布将对微血管再生和COX-2酶提供长期抑制作用，从而防止PDL治疗后RRP复发。我们在本研究中的具体目的是确定PDL与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例成人患者中比较这种新的联合策略与传统的CO2激光治疗。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微血管靶向治疗。如果在本研究中取得成功，这种联合策略将为RRP提供一种新的理想的“保声”治疗方法，它将提供长期有效的RRP治疗，并且在门诊治疗中足够安全方便。

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.