Murono Shigeyuki
Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan.
Auris Nasus Larynx. 2025 Aug;52(4):307-313. doi: 10.1016/j.anl.2025.04.014. Epub 2025 May 9.
Recurrent respiratory papillomatosis (RRP) is a chronic disease characterized by papillomatous growths in the airway, predominantly affecting the larynx and trachea. The disease is generally caused by the low-risk types of human papillomavirus (HPV), HPV6 and HPV11. The incidence and prevalence of RRP vary from country to country, and in Japan the incidence is estimated to be 0.20 per 100,000 adults, according to a recent nationwide survey. The most commonly affected region in the larynx is the true vocal folds. Surgery is the standard treatment, although preferred surgical instruments, such as the carbon dioxide laser, microdebrider, and cold instruments, have shifted over time. Currently the microdebrider is the most commonly used instrument in the United States and Europe, while cold instruments are the most common in Japan. The above-mentioned Japanese nationwide survey analyzed the outcomes of 150 newly diagnosed adult RRP patients who underwent surgery as an initial treatment, and showed that the estimated 1-year and 2-year recurrence-free rates according to the Kaplan-Meier curve were 55.8 % and 47.9 %, respectively. Recurrence was also significantly more common in patients with lesions in multiple regions than those with lesion(s) in a single region. Due to the intractable nature of the disease, adjuvant therapy is often required to control it. Although there are no standard drugs that are used with RRP, several agents have been used in clinical practice, including the intralesional injection of cidofovir, the intralesional or systemic injection of bevacizumab, and the HPV vaccine. Immunological approaches that enhance antitumor T-cell responses, such as immune checkpoint inhibitors, have also gained attention. To date, only a few small randomized controlled trials of surgery and pharmacotherapy for RRP have been published. Further research with larger cohorts and longer follow-up periods is needed to determine the appropriate treatment strategy for RRP.
复发性呼吸道乳头状瘤病（RRP）是一种慢性疾病，其特征是气道内出现乳头状瘤样生长，主要影响喉部和气管。该疾病通常由人乳头瘤病毒（HPV）的低风险类型HPV6和HPV11引起。RRP的发病率和患病率因国家而异，根据最近的一项全国性调查，日本的发病率估计为每10万成年人中有0.20例。喉部最常受累的区域是真声带。手术是标准治疗方法，尽管随着时间的推移，诸如二氧化碳激光、微型清创器和冷器械等首选手术器械已经发生了变化。目前，微型清创器是美国和欧洲最常用的器械，而冷器械在日本最为常见。上述日本全国性调查分析了150例新诊断的成年RRP患者接受手术作为初始治疗的结果，根据Kaplan-Meier曲线显示，估计的1年和2年无复发生存率分别为55.8%和47.9%。与单个区域有病变的患者相比，多个区域有病变的患者复发也明显更常见。由于该疾病难以治疗，通常需要辅助治疗来控制它。虽然RRP没有标准使用的药物，但临床上已经使用了几种药物，包括病灶内注射西多福韦、病灶内或全身注射贝伐单抗以及HPV疫苗。增强抗肿瘤T细胞反应的免疫疗法，如免疫检查点抑制剂，也受到了关注。迄今为止，关于RRP手术和药物治疗的小型随机对照试验仅发表了少数几项。需要进行更大样本量队列和更长随访期的进一步研究，以确定RRP的合适治疗策略。
