Voice-preserved therapy of laryngeal papilloma in children

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。此外，这种疾病很难治愈，因为它有很强的复发倾向。因此，创伤手术和术后复发可能是目前RRP治疗中最具挑战性的两个问题。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、创伤较小的治疗这种疾病的努力的继续。在这项研究中，我们将确定一种新的PDL和膳食补充剂(二吲哚甲烷，DIM)的联合治疗方法，用于治疗RRP儿童。我们的假设是，术后应用DIM将对RRP病变提供长期的抑制作用，从而延缓或防止PDL治疗后RRP的复发。我们在这项研究中的具体目的是确定DIM在预防PDL术后RRP复发方面的长期疗效。我们还将确定病变复发的时间进程，并将进行实验室测试，以确定DIM的治疗副作用(如果有)。我们将在30名患有RRP的儿童(各15名)中，将这种新的联合策略与单纯PDL治疗进行比较。这是首次将这种新的激光MVT技术与DIM相结合，用于儿童的RRP治疗。如果在这项拟议的研究中成功，这种联合策略将提供一种新的、理想的“保声”RRP疗法，它将减少对声带的损伤，并提供长期的治疗效果。这对于门诊治疗来说是足够安全和方便的。

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.