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Bevacizumab i cidofovir w leczeniu HPV-zależnej brodawczakowatości krtani – przegląd literatury

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Jackowska J., Piersiala K., Klimza H., Wierzbicka M.
Polish Journal of Otolaryngology
|
2018
|
vol. 72
|
issue 4
1-8
PL
Cel: Brodawczakowatość krtani to choroba wywoływana przez wirus brodawczaka ludzkiego (HPV) typu 6 lub 11, która dotyczy zarówno dzieci, jak i dorosłych. Cechą charakterystyczną tej jednostki chorobowej są łagodne brodawczaki – będące proliferującym nabłonkiem płaskim – w obrębie układu oddechowego oraz pokarmowego. Największym problemem w leczeniu brodawczakowatości jest wysoka częstość nawrotów po zastosowaniu leczenia chirurgicznego. Materiały i metody: Przeglądu literatury dokonano na podstawie dostępnych publikacji w bazach danych, tj. MedLine (US National Library of Medicine), PubMed oraz SciELO. Wszystkie publikacje w języku angielskim zostały poddane analizie (w tym badania przekrojowe, prospektywne, retrospektywne, przeglądy literatury oraz opisy przypadku). Wyniki: W najnowszej dostępnej literaturze rekomenduje się kilka sposobów leczenia brodawczakowatości krtani, w tym mechaniczny debulking za pomocą lasera CO2 oraz użycie terapii adjuwantowej. Śródnabłonkowe wstrzyknięcia bevacizumabu i cidofoviru wydłużają okresy pomiędzy kolejnymi zabiegami chirurgicznymi oraz zmniejszają liczbę koniecznych operacji w ciągu roku. Wnioski: Europejskie Towarzystwo Laryngologiczne (ELS) nadal nie jest zgodne co do przewagi zalet nad skutkami ubocznymi terapii adjuwantowej w brodawczakowatości krtani. Przegląd literatury natomiast wskazuje na obiecujące długoterminowe korzyści płynące z zastosowania tej terapii. Bevacizumab oraz cidovofir przynoszą największe efekty w leczeniu zwłaszcza agresywnej postaci brodawczakowatości.
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Outcomes of bevacizumab and cidofovir treatment in HPV-associated recurrent respiratory papillomatosis – review of the literature.

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Jackowska J., Piersiala K., Klimza H., Wierzbicka M.
Polish Journal of Otolaryngology
|
2018
|
vol. 72
|
issue 4
1-8
EN
Objective: Recurrent respiratory papillomatosis (RRP) is caused by types 6 and 11 human papilloma virus and occurs in both children and adults. It is characterized by proliferation of benign squamous cell papillomas within the aerodigestive tract. The problem with recurrent respiratory papillomatosis treatment is high recurrence of papilloma growth following surgical removal. Method: A literature review was carried out via surveys based on electronic data in public domains: MedLine (USA National Library of Medicine), PubMed and SciELO, using keywords such as: recurrent respiratory papillomatosis, adjuvant treatment, cidofovir, and bevacizumab. All types of papers written in English were included (cross-sectional, prospective and retrospective clinical trials, review papers, and case reports). Results: In the recent literature, several types of treatment such as surgery with mechanical debulking or laser and adjuvant therapies are mentioned. Intralesional bevacizumab and cidofovir treatment may increase the interval between surgical procedures and decrease the number of procedures per year. Conclusions: There is still an ongoing discussion within the European Laryngological Society regarding the balance between effectiveness and side effects of RRP adjuvant treatment, however, recent results show promising long-term effects. Bevacizumab and cidofovir in aggressive RRP give hope for improved treatment outcomes.
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Narrow band imaging in transoral laser microsurgery (TLM) in moderately advanced (T2, T3) glottic cancer

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Piersiala K., Klimza H., Jackowska J., Majewska A., Wierzbicka M.
Polish Journal of Otolaryngology
|
2018
|
vol. 72
|
issue 5
17-23
EN
Introduction: Treatment planning in T2, T3 laryngeal carcinoma is based on clinical assessment and radiological imaging. However, to delineate precise mucosal margins for transoral laser microsurgery (TLM), a high class, sophisticated endoscopy is indispensable. Narrow band imaging (NBI) which is an optical filter technology, seems to be a useful adjunctive tool in marking superficial margins. Materials and Methods: A total of 98 patients diagnosed with HNSCC underwent cordectomies and were enrolled in the evaluation. T2 and T3 stage cancer was diagnosed in 90 and 8 patients, respectively. Intraoperatively, prior to the first laser shot, all anatomical sites were endoscopically evaluated by WL and NBI. Results: In 10/98 patients (10.2%), 10 samples were taken based only on NBI findings to guarantee better delineation of superficial margins. The result of histology revealed moderate dysplasia in 4 cases (40%), severe dysplasia in 2 (20%), carcinoma in situ in 3 (30%) and hyperkeratosis in 1 (10%). Based on presented results, combined NBI/WL endoscopy reached sensitivity of 100%, specificity 98.88%, positive predictive value 90%, negative predictive value 100% and accuracy 98.98%. All patients had clear margins according to definitive histology results. Discussion: In this paper, we aimed to assess the usefulness of NBI in intraoperative imaging of laryngeal mucosa and delineation of superficial margins in patients with selected T2 and T3 laryngeal cancer treated with TLM. We proved in our study that with the support of NBI endoscopy, it is possible to increase accuracy of superficial resection margins in patients with moderately advanced laryngeal cancer (T2, T3).
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