Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, AZ, USA.
Division of Health Science Research, Mayo Clinic, AZ, USA.
Ann Otol Rhinol Laryngol. 2021 Oct;130(10):1164-1170. doi: 10.1177/0003489421998215. Epub 2021 Mar 1.
The goal of this study was to evaluate the benefit of sublesional bevacizumab injection for recurrent respiratory papillomatosis (RRP) as used in a typical clinical practice.
A retrospective review of patients with RRP treated between 2011 and 2016 was undertaken. All patients were treated with in-office potassium titanyl phosphate (KTP) laser photoablation. Sublesional bevacizumab injection was used based on joint patient-physician decision making. Papilloma burden was objectively measured on prior recordings by 2 blinded reviewers and described as vocal fold segments affected (VFSA) by papilloma. Each patient served as their own control by comparing times when bevacizumab was or was not used. Mixed model for longitudinal data was used to determine if the previous use of bevacizumab decreased the disease burden.
A total of 19 patients met inclusion criteria and all prior laryngoscopic exams were reviewed for VFSA as described above. The mean (SD) number of VFSA when bevacizumab was not used at the prior procedure was 15 (14) as compared to 8 (11) when bevacizumab was used. When adjusted for age, time from initial presentation and baseline disease burden, mixed model showed a decrease of 11 VFSA (95% CI 6.5, 15.5, < .0001) when bevacizumab was used as compared to when bevacizumab was not used at the prior procedure. In mixed model analysis, there was not a significant association between bevacizumab dose used and VFSA at the subsequent visit ( = .8).
Using sublesional bevacizumab intermittently based on clinical findings appears to be effective in improving disease control. Papilloma burden is significantly decreased at the subsequent clinical follow-up following injection of sublesional bevacizumab. The beneficial effect of sublesional bevacizumab may be not be dose-dependent.
本研究旨在评估亚病灶贝伐单抗注射在典型临床实践中对复发性呼吸道乳头瘤病（RRP）的益处。
对 2011 年至 2016 年期间接受治疗的 RRP 患者进行回顾性研究。所有患者均接受门诊钾钛磷（KTP）激光光消融治疗。亚病灶贝伐单抗注射根据患者和医生的共同决策进行。两位盲审员根据先前的记录客观测量乳头状瘤负担，并描述为受乳头状瘤影响的声带段（VFSA）。每位患者均通过比较使用贝伐单抗和不使用贝伐单抗的时间来作为自身对照。采用纵向数据混合模型来确定贝伐单抗的先前使用是否降低了疾病负担。
共有 19 名患者符合纳入标准，对所有先前的喉镜检查均进行了如上所述的 VFSA 评估。与未使用贝伐单抗时的前一次手术相比，当未使用贝伐单抗时，VFSA 的平均值（标准差）为 15（14），而当使用贝伐单抗时，VFSA 的平均值（标准差）为 8（11）。在调整年龄、从初次就诊到当前的时间和基线疾病负担后，混合模型显示，与前一次手术未使用贝伐单抗相比，当使用贝伐单抗时，VFSA 减少了 11 个（95%置信区间为 6.5，15.5， < .0001）。在混合模型分析中，贝伐单抗使用剂量与后续就诊时的 VFSA 之间没有显著关联（ = .8）。
根据临床发现间歇性使用亚病灶贝伐单抗似乎可有效改善疾病控制。在注射亚病灶贝伐单抗后，随后的临床随访中乳头状瘤负担明显降低。亚病灶贝伐单抗的有益效果可能不是剂量依赖性的。
