Clinical and epidemiological characteristics of recurrent larynx papillomatosis. Retrospective study from 2012 to 2017
Abstract Introduction and objective: Laryngeal papillomatosis represent the most frequent benign tumor of the larynx, with recurrent respiratory papillomatosis (RRP) being its most complex clinical presentation. This entity, with low worldwide prevalence, is associated with a significant impact on the patients´ economy and quality of life. There is limited data on its epidemiological profile in Latin America. The objectives of this study are to identify the clinical, epidemiological, treatment and follow-up characteristics proper to this entity and specific for our region. Method: A retrospective observational study that describes all patients with RRP attended in the ENT department of Teodoro Maldonado Carbo Specialty Hospital (Guayaquil-Ecuador), over a period of 5 years. Results: 34 patients with RRP were identified. 88,24% were adult onset RRP. Male/female ratio was 2,09:1. The age of diagnosis varied from 3-75 years with an average of 45,41 years. The predominant symptom was dysphonia in 97,06%. The main anatomical site of injury was the vocal cords in 85,29%. 23 patients had a surgery in our institution (67,65%).15 patients presented squamous papilloma without dysplasia (65,21%). We identified 5 patients in remission, 5 with persistence and 13 with post-surgical recurrences. Discussion: Annual frequency of RRP was higher than reported in international literature. There were variations regarding age and sex distribution, and percentages of dysplasia and malignancy. No differences were observed in the frequency of symptoms, time of evolution, anatomical location, number of previous surgeries, or post-surgical recurrences. Conclusions: Adult onset RRP was the most frequent presentation, with male sex predilection and a bimodal age distribution. The main symptom at diagnosis was dysphonia associated with a chronic evolution and vocal cords involvement. The age of diagnosis was inversely proportional to the number of previous surgeries but was not related to pre-surgical severity or histopathological diagnosis. The prevalence of post-surgical recurrences dominated in both groups, denoting the aggressiveness of the infection as well as the limitations of unimodal treatment.
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Armstrong LR, Derkay CS, Reeves WC, RRP Task Force. Initial Results From the National Registry for Juvenile-Onset Recurrent Respiratory Papillomatosis. Arch Otolaryngol Head Neck Surg. Jul, 1999;125(7):743-8. DOI: https://doi.org/10.1001/archotol.125.7.743
Campisi P, Hawkes M, Simpson K, Canadian Juvenile Onset Recurrent Respiratory Papillomatosis Working Group. The epidemiology of juvenile onset recurrent respiratory papillomatosis derived from a population level national database. Laryngoscope. Jun,2010;120(6):1233-45. DOI: https://doi.org/10.1002/lary.20901
Carifi M, Napolitano D, Morandi M, Dall’Olio D. Recurrent respiratory papillomatosis: current and future perspectives. Ther Clin Risk Manag. May,2015;11:731-8. DOI: https://doi.org/10.2147/TCRM.S81825
Cortés F, Ascencio M, González E. GPC. Diagnóstico y Tratamiento quirúrgico de Papilomatosis Laríngea Juvenil. México: 2010. Disponible en: http://www.cenetec.salud.gob.mx/descargas/gpc/CatalogoMaestro/557_GPC_Papilomatosislarxngea/GER_Papilomatosis.pdf
Davids T, Muller S, Wise JC, Johns MM, Klein A. Laryngeal Papillomatosis Associated Dysplasia in the Adult Population: An Update on Prevalence and HPV Subtyping. Ann Otol Rhinol Laryngol. Jun, 2014;123(6):402-8. DOI: https://doi.org/10.1177/0003489414526848
Dedo HH, Yu KC. CO2 laser treatment in 244 patients with respiratory papillomas. Laryngoscope. 2001;111(9): 1639-44. DOI: https://doi.org/10.1097/00005537-200109000-00028
Derkay CS. Task Force on Recurrent Respiratory Papillomas: A Preliminary Report. Arch Otolaryngol Head Neck Surg.1995;121(12):1386–91. DOI: https://doi.org/10.1001/archotol.1995.01890120044008
Donne AJ, Hampson L, Homer JJ, Hampson IN. The role of HPV type in Recurrent Respiratory Papillomatosis. Int J Pediatr Otorhinolaryngol. Jan, 2010;74(1):7-14. DOI: https://doi.org/10.1016/j.ijporl.2009.09.004
Fusconi M, Grasso M, Greco A, Gallo A, Campo F, Remacle M, et al. Recurrent respiratory papillomatosis by HPV: review of the literature and update on the use of cidofovir. Acta Otorhinolaryngol Ital.Dec,2014;34(6):375-81. PMID:25762828
Gutiérrez C, Monerris E, Duran M, Sancho M, Gras J. Papillomas & laryngeal papillomatosis. Treatment with CO2 laser surgery. Our experience over 15 years. Acta Otorrinolaringol Esp (English Edition). 2010;61(6):422-27. DOI: https://doi.org/10.1016/S2173-5735(10)70078-8
Hamza AH, Nasr MM, Deghady AA. The use of mitomycin-C for respiratory papillomas: clinical, histologic and biochemical correlation. Saudi Med J. 2005;26(11):1737-45. PMID:16311658
Harman E. Recurrent Respiratory Papillomatosis. Medscape. Mosenifar Z. (Ed), Updated: Dec 31, 2015. Disponible en:http://emedicine.medscape.com/article/302648-overview
Larson DA, Derkay CS. Epidemiology of recurrent respiratory papillomatosis. APMIS. Jun,2010;118(6-7):450-4. DOI: https://doi.org/10.1111/j.1600-0463.2010.02619.x
Leahy K, Friedman O, Thayer R. Laryngeal Papilloma. En: Thayer Sataloff R. Clinical Assessment of Voice. 2ª ed. San Diego, CA: Plural Publishing; 2017. p.387-95.
Lindeberg H, Elbrønd O. Laryngeal papillomas: the epidemiology in a Danish subpopulation 1965–1984. Clin. Otolaryngol. Apr,1990;15(2):125-31. DOI: https://doi.org/10.1111/j.1365-2273.1990.tb00444.x
McKenna M, Brodsky L. Extraesophageal acid reflux and recurrent respiratory papilloma in children. Int J Pediatr Otorhinolaryngol. May,2005;69(5):597-605. DOI: https://doi.org/10.1016/j.ijporl.2004.11.021
Omland T, Akre H, Lie KA, Jebsen P, Sandvik L, Brøndbo K. Risk Factors for Aggressive Recurrent Respiratory Papillomatosis in Adults and Juveniles. PLoS One. Nov,2014;9(11):1-13. DOI: https://doi.org/10.1371/journal.pone.0113584
Pachar J, Rodríguez G, Barraza M, Trejos D. Asfixia por papilomatosis respiratoria recurrente. Rev Esp Med Legal.2015;42(1):37-40. DOI: https://doi.org/10.1016/j.reml.2015.07.002
Peñaloza M, Montoya H, Flores SE, Fierro FJ, Peñaloza JM, Sánchez J. Molecular Identification of 7 Human Papillomavirus Types in Recurrent Respiratory Papillomatosis. Arch Otolaryngol Head Neck Surg. Sep, 2000;126(9):1119-23. DOI: https://doi.org/10.1001/archotol.126.9.1119
Roh J-L, Yoon Y-H. Prevention of Anterior Glottic Stenosis after Transoral Microresection of Glottic Lesions Involving the Anterior Commissure with Mitomycin C. Laryngoscope. 2005; 115:1055–9. DOI: https://doi.org/10.1097/01.MLG.0000163341.67553.B9
Silverberg MJ, Thorsen P, Lindeberg H, Ahdieh-Grant L, Shah KV. Clinical Course of Recurrent Respiratory Papillomatosis in Danish Children. Arch Otolaryngol Head Neck Surg. Jun, 2004;130(6):711-6. DOI: https://doi.org/10.1001/archotol.130.6.711
Soto-Posada MI, Tamez-Velarde M, Domínguez-Sosa FR. Papilomatosis respiratoria recurrente, resultados del tratamiento con láser de CO2 en un centro de referencia; experiencia de seis años. An Orl Mex. 2014;59(2):92-101.
Weller MD, Nankivell PC, McConkey C, Paleri V, Mehanna HM. The risk and interval to malignancy of patients with laryngeal dysplasia: a systematic review of case series and meta-analysis. Clin Otolaryngol.2010;35(5):364-72. DOI: https://doi.org/10.1111/j.1749-4486.2010.02181.x
Wiatrak BJ, Wiatrak DW, Broker TR, Lewis L. Recurrent Respiratory Papillomatosis: A Longitudinal Study Comparing Severity Associated With Human Papilloma Viral Types 6 and 11 and Other Risk Factors in a Large Pediatric Population. Laryngoscope. Nov,2004;114(S104):1-23. DOI: https://doi.org/10.1097/01.mlg.000148224.83491.0f
Campisi P, Hawkes M, Simpson K, Canadian Juvenile Onset Recurrent Respiratory Papillomatosis Working Group. The epidemiology of juvenile onset recurrent respiratory papillomatosis derived from a population level national database. Laryngoscope. Jun,2010;120(6):1233-45. DOI: https://doi.org/10.1002/lary.20901
Carifi M, Napolitano D, Morandi M, Dall’Olio D. Recurrent respiratory papillomatosis: current and future perspectives. Ther Clin Risk Manag. May,2015;11:731-8. DOI: https://doi.org/10.2147/TCRM.S81825
Cortés F, Ascencio M, González E. GPC. Diagnóstico y Tratamiento quirúrgico de Papilomatosis Laríngea Juvenil. México: 2010. Disponible en: http://www.cenetec.salud.gob.mx/descargas/gpc/CatalogoMaestro/557_GPC_Papilomatosislarxngea/GER_Papilomatosis.pdf
Davids T, Muller S, Wise JC, Johns MM, Klein A. Laryngeal Papillomatosis Associated Dysplasia in the Adult Population: An Update on Prevalence and HPV Subtyping. Ann Otol Rhinol Laryngol. Jun, 2014;123(6):402-8. DOI: https://doi.org/10.1177/0003489414526848
Dedo HH, Yu KC. CO2 laser treatment in 244 patients with respiratory papillomas. Laryngoscope. 2001;111(9): 1639-44. DOI: https://doi.org/10.1097/00005537-200109000-00028
Derkay CS. Task Force on Recurrent Respiratory Papillomas: A Preliminary Report. Arch Otolaryngol Head Neck Surg.1995;121(12):1386–91. DOI: https://doi.org/10.1001/archotol.1995.01890120044008
Donne AJ, Hampson L, Homer JJ, Hampson IN. The role of HPV type in Recurrent Respiratory Papillomatosis. Int J Pediatr Otorhinolaryngol. Jan, 2010;74(1):7-14. DOI: https://doi.org/10.1016/j.ijporl.2009.09.004
Fusconi M, Grasso M, Greco A, Gallo A, Campo F, Remacle M, et al. Recurrent respiratory papillomatosis by HPV: review of the literature and update on the use of cidofovir. Acta Otorhinolaryngol Ital.Dec,2014;34(6):375-81. PMID:25762828
Gutiérrez C, Monerris E, Duran M, Sancho M, Gras J. Papillomas & laryngeal papillomatosis. Treatment with CO2 laser surgery. Our experience over 15 years. Acta Otorrinolaringol Esp (English Edition). 2010;61(6):422-27. DOI: https://doi.org/10.1016/S2173-5735(10)70078-8
Hamza AH, Nasr MM, Deghady AA. The use of mitomycin-C for respiratory papillomas: clinical, histologic and biochemical correlation. Saudi Med J. 2005;26(11):1737-45. PMID:16311658
Harman E. Recurrent Respiratory Papillomatosis. Medscape. Mosenifar Z. (Ed), Updated: Dec 31, 2015. Disponible en:http://emedicine.medscape.com/article/302648-overview
Larson DA, Derkay CS. Epidemiology of recurrent respiratory papillomatosis. APMIS. Jun,2010;118(6-7):450-4. DOI: https://doi.org/10.1111/j.1600-0463.2010.02619.x
Leahy K, Friedman O, Thayer R. Laryngeal Papilloma. En: Thayer Sataloff R. Clinical Assessment of Voice. 2ª ed. San Diego, CA: Plural Publishing; 2017. p.387-95.
Lindeberg H, Elbrønd O. Laryngeal papillomas: the epidemiology in a Danish subpopulation 1965–1984. Clin. Otolaryngol. Apr,1990;15(2):125-31. DOI: https://doi.org/10.1111/j.1365-2273.1990.tb00444.x
McKenna M, Brodsky L. Extraesophageal acid reflux and recurrent respiratory papilloma in children. Int J Pediatr Otorhinolaryngol. May,2005;69(5):597-605. DOI: https://doi.org/10.1016/j.ijporl.2004.11.021
Omland T, Akre H, Lie KA, Jebsen P, Sandvik L, Brøndbo K. Risk Factors for Aggressive Recurrent Respiratory Papillomatosis in Adults and Juveniles. PLoS One. Nov,2014;9(11):1-13. DOI: https://doi.org/10.1371/journal.pone.0113584
Pachar J, Rodríguez G, Barraza M, Trejos D. Asfixia por papilomatosis respiratoria recurrente. Rev Esp Med Legal.2015;42(1):37-40. DOI: https://doi.org/10.1016/j.reml.2015.07.002
Peñaloza M, Montoya H, Flores SE, Fierro FJ, Peñaloza JM, Sánchez J. Molecular Identification of 7 Human Papillomavirus Types in Recurrent Respiratory Papillomatosis. Arch Otolaryngol Head Neck Surg. Sep, 2000;126(9):1119-23. DOI: https://doi.org/10.1001/archotol.126.9.1119
Roh J-L, Yoon Y-H. Prevention of Anterior Glottic Stenosis after Transoral Microresection of Glottic Lesions Involving the Anterior Commissure with Mitomycin C. Laryngoscope. 2005; 115:1055–9. DOI: https://doi.org/10.1097/01.MLG.0000163341.67553.B9
Silverberg MJ, Thorsen P, Lindeberg H, Ahdieh-Grant L, Shah KV. Clinical Course of Recurrent Respiratory Papillomatosis in Danish Children. Arch Otolaryngol Head Neck Surg. Jun, 2004;130(6):711-6. DOI: https://doi.org/10.1001/archotol.130.6.711
Soto-Posada MI, Tamez-Velarde M, Domínguez-Sosa FR. Papilomatosis respiratoria recurrente, resultados del tratamiento con láser de CO2 en un centro de referencia; experiencia de seis años. An Orl Mex. 2014;59(2):92-101.
Weller MD, Nankivell PC, McConkey C, Paleri V, Mehanna HM. The risk and interval to malignancy of patients with laryngeal dysplasia: a systematic review of case series and meta-analysis. Clin Otolaryngol.2010;35(5):364-72. DOI: https://doi.org/10.1111/j.1749-4486.2010.02181.x
Wiatrak BJ, Wiatrak DW, Broker TR, Lewis L. Recurrent Respiratory Papillomatosis: A Longitudinal Study Comparing Severity Associated With Human Papilloma Viral Types 6 and 11 and Other Risk Factors in a Large Pediatric Population. Laryngoscope. Nov,2004;114(S104):1-23. DOI: https://doi.org/10.1097/01.mlg.000148224.83491.0f
Ávila-Suárez, E. M., & Naranjo-Chiluiza, V. G. (2019). Clinical and epidemiological characteristics of recurrent larynx papillomatosis. Retrospective study from 2012 to 2017. Revista ORL, 11(2), 117–128. https://doi.org/10.14201/orl.21763
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