acyclovir and Papilloma

Respiratory papillomatosis affects the larynx in most cases. It is a relatively rare disease, with potentially devastating consequences for the patient. Many studies have proven the viral etiology of the disease. Surgery is the most successful mode of treatment. Adjuvant therapy is used in cases of aggressive disease. The most successful adjuvant drugs are interferon, various virostatics (e.g., acyclovir, valacyclovir, and cidofovir) and indole-3-carbinol. Vaccination with a quadrivalent vaccine against HPV will probably decrease the incidence of respiratory papillomatosis or help in the treatment of the disease in the future. The results of adjuvant therapy of laryngeal papillomatosis at the University Department of ORL & HNS in Ljubljana are comparable to the results in other centers around the world.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Anticarcinogenic Agents; Antiviral Agents; Chemotherapy, Adjuvant; Child; Child, Preschool; Cidofovir; Cytosine; Female; Humans; Indoles; Infant; Laryngeal Diseases; Male; Middle Aged; Organophosphonates; Papilloma; Papillomavirus Vaccines; Vaccination; Valacyclovir; Valine

Multiple papilloma of larynx is caused by human papilloma virus. We treated sixteen such cases (10 males and six females) in the last 10 years. All presented with hoarseness while six presented with difficulty in respiration. Three patients needed tracheostomy, all had difficult decanulation, and one developed laryngotracheal stenosis and could not be decanulated. All were treated by surgical excision; ten had recurrence. Four patients were treated with post operative Acyclovir with no recurrence in three cases.

Topics: Acyclovir; Child; Child, Preschool; Female; Humans; Laryngeal Neoplasms; Laryngoscopy; Male; Papilloma; Papillomavirus Infections; Prognosis; Retrospective Studies; Tracheostomy; Tumor Virus Infections

Six patients with severe, recalcitrant, juvenile-onset recurrent respiratory papillomatosis were treated with 7 independent trials of acyclovir. In 2 trials, patients received acyclovir in place of interferon-alpha; the remaining 5 trials were in patients not otherwise receiving chemotherapy. Quantitative analysis of overall disease extent, laryngeal involvement, and degree of glottic obstruction for the 6 months prior to acyclovir administration and during acyclovir administration demonstrated a statistically significant decrease in all parameters evaluated in those patients who were otherwise unmediated. The 2 patients who discontinued interferon-alpha immediately prior to beginning acyclovir demonstrated worsening disease, consistent with the well-recognized rebound phenomenon associated with stopping interferon. This study suggests that acyclovir decreases the extent of respiratory papillomatosis in patients with recalcitrant disease. The beneficial effect of acyclovir appears to be insufficient to counteract the rebound of disease when interferon is stopped abruptly.

Topics: Acyclovir; Drug Administration Schedule; Humans; Laryngeal Neoplasms; Neoplasm Recurrence, Local; Papilloma; Pilot Projects; Treatment Outcome

Four patients with aggressive respiratory papillomatosis have been treated with oral Acyclovir as adjuvant therapy while continuing to undergo regular endoscopy and laser treatment to the lesions. The duration of Acyclovir administration ranged from 2 weeks to 3 months. Two patients had papillomatosis confined to the larynx and two in addition had disease in the lower respiratory tract. One of the four patients had less aggressive disease during the treatment period. Acyclovir does not appear to significantly influence respiratory papillomatosis. Acyclovir's activity is dependent upon the presence of virally encoded thymidine kinase. This enzyme is not known to be encoded by papilloma viruses. Acyclovir is not recommended in the treatment of juvenile respiratory papillomatosis.

Topics: Acyclovir; Child; Child, Preschool; Female; Humans; Laryngeal Neoplasms; Male; Neoplasms, Multiple Primary; Papilloma; Respiratory Tract Neoplasms

We report the results obtained in a study of 3 young patients with laryngeal papillomatosis, who were treated with acyclovir after tumor excision using forceps was performed under microlaryngoscopy. No recurrence of the papillomatosis occurred between 18 and 42 months post-therapy. Laryngeal papillomatosis is the most common proliferative laryngeal lesion in children. Different non-surgical therapies have been used to prevent its recurrence but with poor results. Acyclovir is a drug with proved efficacy in DNA viral diseases. Since papillomata of the larynx is most likely a viral disease which is imputed to have a DNA virus etiology, acyclovir may be effective to control it.

Topics: Acyclovir; Child; Child, Preschool; Combined Modality Therapy; Female; Glottis; Humans; Laryngeal Neoplasms; Laryngoscopy; Male; Neoplasm Recurrence, Local; Papilloma; Vocal Cords