Voice-preserved therapy of laryngeal papilloma in children

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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. Additionally, this disease is difficult to be cured because of its strong tendency to recur. Thus, the traumatic surgery and postoperative recurrence probably are two the most challenging problems with current RRP treatment. 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 this disease. In this study, we will determine a new and combined treatment of PDL and a dietary supplement (diindolylmethane, DIM), for children with RRP. Our hypothesis is that postoperative administration of DIM will provide a long-term inhibitory effect on RRP lesions, thereby delaying or preventing RRP from recurring after the PDL therapy. Our specific aim in this study is to determine long-term efficacy of DIM in preventing postoperative RRP recurrence, after PDL surgery. We also will determine the time course of the lesion recurrence and will conduct laboratory tests to identify treatment side-effect (if any) with DIM. We will compare this new combined strategy with PDL-only treatment, in 30 children with RRP (15 of each). This is the first time to combine this new laser MVT technique with DIM, for RRP treatment in children. This combined strategy, if successful in this proposed study, will provide a new and ideal "voice-preserving" RRP treatment that will result less trauma to vocal cords and deliver long-term treatment efficacy. It would be safe and convenient enough for an out-patient treatment.