ADJUVANT DRUG STRATEGIES IN THE TREATMENT OF RECURRENT RESPIRATORY PAPILLOMATOSIS

The purpose of this study was to evaluate adjuvant drug therapies comb ined with standard laser excision in the treatment of recurrent respir atory papillomatosis. Previous studies have presented conflicting data on the efficacy of various treatments, including interferon and isotr etinoin. A retrospective study of 34 patients with moderate to severe papillomatosis who underwent both laser surgery and adjuvant therapy w as therefore performed. Ail patients were treated with interferon. Fiv e interferon failures received isotretinoin, and three with recalcitra nt disease received methotrexate, Interferon produced a complete respo nse in 16 patients and partial response in 12 patients. Juvenile-onset disease had a slightly higher response to interferon than adult-onset disease. Isotretinoin produced no response in all five patients, Meth otrexate demonstrated a marked improvement in both severity of disease and treatment interval in all three patients, Serious side effects we re limited to one interferon patient with febrile seizures, which reso lved with discontinuation of therapy. We conclude that adjuvant therap y including interferon and methotrexate is clearly of benefit in the t reatment of patients with respiratory papillomatosis. A detailed appro ach to surgery combined with an interferon dosing regimen is presented , Further study of methotrexate appears warranted.