Disorders Treated

What Is RRP?

RRP is caused by the human papilloma virus (HPV). In affected individuals, this virus resides chronically in the surface tissue or mucosa of the larynx and may induce proliferation of mucosa (surface tissue) into either low-profile velvety or elevated lesions called papillomas. These lesions can occur on the vocal folds, in areas above the vocal folds, and even in the subglottis and trachea. BVI caseload comprises approximately 140 adult-only patients.

The standard of care for this condition remains periodic vocal fold microsurgery to remove papillomas meticulously but with care to avoid injury to underlying vocal fold structures. BVI physicians have extensive experience over 20 years, with adjuvant treatments, including interferon; the so-called “cabbage pill” (indole 3-carbinol, or its active metabolite marketed as DIM); and most recently, cidofovir, Avastin, and artemisinin. In recent years, we have used cidofovir along with surgery with what seems to be in some cases remarkable clinical success.

Across 20 years, we have had many patients on adjunctive treatments such as interferon, I-3-C, cidofovir, artemisinin, and Avastin.   Based upon this experience, we individualize our approach for each patient, but our commonest current methodology is as follows:

New patients–initial “curative” mode.  (“Curative” is in quotes to denote a treatment philosophy only, as we of course know that RRP is stubbornly recurrent in most, but not all patients.) We perform meticulous but conservative removal of visible lesions in the operating room, and inject the base with cidofovir or Avastin.  When travel logistics allow, we perform two additional injections in the videoendoscopy room of BVI at 3-week intervals, to complete a series of three.  On individualized basis, more injections may follow.

Longterm patients with proven and stubbornly recurrent lesions:  — “management” mode.  Individualization is key, but many opt for periodic pulsed-KTP and/ or Thulium laser treatment in a videoendoscopy procedure room, under topical anesthesia. Hundreds of office-based laser treatments have been performed at BVI during the past 10 years.