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Treatment Options for JRRP

There is no cure for JRRP. However, there are options available to patients to help manage and control the symptoms. Please discuss with your physician which option would be the best option for you and your child.

Surgery

There are several surgical options. To maximize visualization during surgery, tubeless suspension microlaryngology is used while the child is under anesthesia. View some surgical videos on this page.

CO2 Laser

The CO2 laser converts light into thermal energy that is absorbed by intracellular water. The result is controlled destruction of tissues by cell vaporization and cautery of tissue surfaces. This laser carries some risk for scarring.

Microdebrider

Using this technique is good when the airway is obstructed and needs to be opened quickly. It is quick and works well in conjunction with other treatment courses. This procedure carries some risk of damage to the vocal folds.

Potassium Titanyl Phosphate (KTP) Laser

The wavelength of this laser is more strongly absorbed by oxyhemoglobin than that of PDL treatment (see below). The extended pulse width allows for a slower and more uniformed coagulation, thereby avoiding undesirable vessel wall rupture. There is less of a chance of scarring with this laser.

Pulse Dye Laser (PDL)

This laser selectively targets the microvasculature of papillomata with minimal damage to surrounding soft tissue. The epithelium can be preserved with this method.

Tracheostomy 

A tracheostomy may activate or contribute to the spread of the disease in the lower respiratory tract. This procedure should be avoided unless required to establish airway, usually in an emergency situation. When it is unavoidable, decannulation should be considered as soon as the disease is managed effectively with endoscopic techniques.

Medical, Nonsurgical Treatment

Cidofovir

An antiviral medicine that is locally injected into the site where the laryngeal papilloma are in the child’s airway that has been suggested to help diminish the number of procedures a child may need in a given year in select patients.

For more information you can review Intralesional Cidofovir for Recurrent Respiratory Papillomatosis in Children, Clinical Update on 10 Children Treated With Intralesional Cidofovir Injections for Severe Recurrent Respiratory Papillomatosis, and Antiviral agents for the treatment of recurrent respiratory papillomatosis: A systematic review of the English-language literature

Avastin- Bevacizumab

A medicine that is locally injected into the site where the laryngeal papilloma are in the child’s airway that has been suggested to help diminish the number of procedures a child may need in a given year in select patients.  It acts by reducing the blood supply to the papilloma and therefore inhibiting its growth.

For more information, you can review Use of 532-nm Pulsed Potassium Titanyl Phosphate Laser and Adjuvant Intralesional Bevacizumab for Aggressive Respiratory Papillomatosis in Children and Local Injection of Bevacizumab (Avastin) and Angiolytic KTP Laser Treatment of Recurrent Respiratory Papillomatosis of the Vocal Folds: A Prospective Study.

Gardasil

Gardasil is a HPV vaccine approved for the prevention of cervical cancer, adenocarcinoma in situ, and cervical intraepiethlial neoplasia, vulvar and vaginal intraepithelial neoplasias, and genital warts associated with HPV 6, 11, 16, and 18. The CDC Advisory Committee on Immunization Practices has recommended vaccination for girls and boys (please speak to your child’s pediatrician about the timing of this for your child).

Gardasil is a prophylactic vaccination, it should not be used to treat those presenting with active RRP, genital warts or cervical cancer. It is unclear at this time whether vaccination of pre-sexually active boys and girls will diminish the rate of their children acquiring JRRP; it is hoped so. It is currently not suggested that previously exposed children or children with JRRP receive Gardasil, although this is being looked at closely.

Indole-3-Carbinol (I3C)

I3C is a FDA-approved nutritional supplement found in high concentration in cruciferous vegetables such as broccoli, cabbage, brussel sprouts, and cauliflower that has been suggested as possibly having some role in decreasing the severity of JRRP.

Sources
Craig S. Derkay, MD; Brian Wiatrak, MD. Recurrent Respiratory Papillomatosis: A Review. Laryngoscope. 2008 Jul;118(7):1236-47.
Clark A. Rosen and Paul C. Bryson. Indole-3-Carbinol for Recurrent Respiratory Papillomatosis: Long-Term Results. Journal of Voice, Vol. 18, No. 2, pp. 248–253
Derkay CS, Malis JM, Zalzal G, Wiatrak BJ, Kashima HK, Coltera MD. A staging system for assessing severity of disease and response to therapy in recurrent respiratory papillomatosis. Laryngoscope. 1998;108:935–937.

 

Table of suggested pediatric dosing as described in the following article (please speak to your pediatrician or Pediatric ENT BEFORE using this or any other medicine)

Rosen CA, Woodson GE, Thompson JW, Hengesteg AP, Bradlow HL. Preliminary results of the use of indole-3-carbinol for recurrent respiratory papillomatosis Otolaryngol Head Neck Surg 1998;118:810-5.
Clark A. Rosen and Paul C. Bryson. Indole-3-Carbinol for Recurrent Respiratory Papillomatosis: Long-Term Results. Journal of Voice, Vol. 18, No. 2, pp. 248–253

DIM

3,3-Diindolylmethane (DIM) is a dietary indole from cruciferous vegetables that has demonstrated pre-clinical therapeutic efficacy in models of human papilloma virus (HPV) related disease. Indole-3-carbinol is the immediate molecular precursor of DIM, so DIM and I3C are related substances.

For more information, please see the following article and/ or ask your pediatrician or Pediatric ENT:
Zeligs, M.A., Sepkovic, D.W., Manrique, C., Macsalka, M., Williams, D.E.,and Bradlow, H.L. Absorption-enhanced 3,3’-Diindolylmethane: Human Use in HPV-related, Benign and Pre-cancerous Conditions. Proc. Am. Assoc. Cancer Res. 2003, Apr; 44.

The ClinicalTrials.gov identifier is NCT00591305

Mumps

The Mumps vaccine contains a live attenuated virus of the Lynn strain with a long history of safe use. In 1980, it was suggested that the mumps and human papillomaviruses might have similarities that could translate into papilloma treatment by simple immunization using mumps vaccine.  The human papillomavirus is a papovavirus in the group of DNA viruses, and the mumps virus is a paramyxovirus in the family of RNA viruses.

For more information, please see the following article:
Nigel R. T. Pashley, Can Mumps Vaccine Induce Remission in Recurrent Respiratory Papilloma? Arch Otolaryngol Head Neck Surg. 2002;128:783-786

Other

There are lists of other adjuvant therapies that this website may not have listed.  Please speak with your pediatrician or pediatric ENT if there specific adjuvant therapies you have questions about
 

On the Horizon

Please read this fascinating article by a team of researchers in Washington DC who are working on a novel technique to be able to test a patient’s tissue to see which adjuvant therapy might work the best.

Use of Reprogrammed Cells to Identify Therapy for Respiratory Papillomatosis

This technology may have helped identify a treatment for a patient with a previously untreatable pulmonary RRP.  Long term results are still pending.