Safety of Intralesional Cidofovir for Adjuvant Treatment of Recurrent Respiratory Papillomatosis

Safety of Intralesional Cidofovir for Adjuvant Treatment of Recurrent Respiratory Papillomatosis: This case series examines the safety of adjuvant intralesional cidofovir injections in patients with recurrent respiratory papillomatosis.




Original Investigation

January 2, 2020

Evaluation of Safety of Intralesional Cidofovir for Adjuvant Treatment of Recurrent Respiratory Papillomatosis

Rebecca C. Hoesli, MD1; Aaron L. Thatcher, MD2; Norman D. Hogikyan, MD2; et alRobbi A. Kupfer, MD2

Author Affiliations

1Bastian Voice Institute, Downers Grove, Illinois

2Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor

JAMA Otolaryngol Head Neck Surg. Published online January 2, 2020. doi:https://doi.org/10.1001/jamaoto.2019.4029



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Key Points

Question  Is intralesional injection of cidofovir safe to use as an adjuvant therapy for recurrent respiratory papillomatosis?



Finding  In this case series including 154 patients, intralesional injection of cidofovir was not associated with increased risk of dysplasia or carcinoma or a statistically significant increase in complications.



Meaning  Intralesional cidofovir injections may be considered for adjuvant therapy in patients with a high burden of disease with recurrent respiratory papillomatosis.



Abstract

Importance  The use of intralesional cidofovir injections for recurrent respiratory papillomatosis (RRP) remains controversial owing to concern regarding the risks of its use, including increased risk of dysplasia or carcinogenesis.



Objective  To describe the rates of dysplasia, development of malignant lesions, and adverse events associated with use of intralesional cidofovir injections as adjuvant treatment for RRP compared with patients treated without adjuvant cidofovir.



Design, Setting, and Participants  In this case series performed at a tertiary care referral center, review of electronic medical records on all adult and pediatric patients (N = 154) treated for RRP with adequate follow-up from January 1, 2000, to December 31, 2016, was performed. Data were collected on the use of cidofovir, development and presence of dysplasia or malignant lesions, complications, and intersurgical interval.



Exposures  Adjuvant intralesional cidofovir or surgical excision only.



Main Outcomes and Measures  The main outcomes measured were the development of dysplasia, malignant lesions, and complications from treatment. These outcomes were determined before collection of data.



Results  Of the 154 patients included in the analysis, 83 patients (53.9%) received adjuvant intralesional cidofovir and 71 patients (46.1%) underwent surgical excision only. One hundred patients (64.9%) were male; mean age was 27.7 (95% CI, 24.3-31.2) years. Patients were followed up for a median (interquartile range) of 70 (24-118) months in the noncidofovir group and 91 (47-152) months in the cidofovir group. There were no statistically significant differences in the rates of development of dysplasia (2.8%; 95% CI, −8.3% to 13.2%) or malignant lesions (2.2%; 95% CI, −5.3% to 11.2%) between the groups. No nephrotoxic effects were observed in the treated cohort, and only 5 minor complications that occurred in 628 injections were noted in the cidofovir group; 3 were related to direct laryngoscopy and 2 were related to needle malfunction.



Conclusions and Relevance  In this cohort of patients with RRP, adjuvant intralesional cidofovir injections did not appear to cause major complications or an increased rate of development of dysplasia and cancer.





Laryngology Oncology Otolaryngology Surgery Pediatric Cancer Pediatrics