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Clinical evaluation of pediatric patients with recurrent respiratory papillomatosis.

A longitudinal study at a Saudi Arabian tertiary care center

Nasser Almutairi, Alanoud Alshathri, Waleed Alshareef, Abdullah Sindi, Abdullah Aljasser and Ahmed Alammar
Saudi Medical Journal February 2024, 45 (2) 205-210; DOI: https://doi.org/10.15537/smj.2024.45.2.20230529

Article Figures & Data

Tables

  • Table 1

    - Individual data of the included patients.

    IDGenderAge at diagnosis (years)Anatomical location of diseaseSymptoms at initial presentationSymptoms at the last clinic visitLength of follow-up (months)Total number of proceduresNumber of Cidofovir sessionsNumber of Avastin sessionsClinical outcomes
    1F4Ant. commissure, Lt. VCAphonia, choking, cough, dyspnea on exertionHoarseness, noisy breathing on exertion12430Partial
    2F11Ant. commissure, Lt. arytenoid, Rt. and Lt. VC, Lt. false VC, subglottic, trachea posterior wallHoarseness, noisy breathing, dyspnea on exertionNoisy breathing15926122Partial
    3F2Rt. aryepiglottic fold, Lt. arytenoid, Rt. false VCHoarseness, biphasic stridor, dyspnea on exertionHoarseness, and noisy breathing on exertion90650Complete
    4F4Laryngeal surface of epiglottis, Rt. and Lt. VC, Rt. and Lt. false VC, ant. commissureHoarseness, noisy breathing during sleep and exertionHoarseness and cough13650Persistent
    5M9Ant. commissure, post-commissure, Rt. and Lt. VC, false VC, subglottic, post-nasopharyngeal wall, Rt. lateral nasopharyngeal wall, Lt. MT and nasal septumHoarseness, dysphagia, and stridorHoarseness7545Persistent
    6M3Ant. commissure, Rt. and Lt. VC, Rt. and Lt. false VCHoarseness, noisy breathing on exertionHoarseness3016411Partial
    7M3Lt. VCHoarseness, aphonia, dyspnea, noisy breathingCough581558Complete
    8F1Ant. commissure, Lt. VC, Lt. false VCHoarseness, weak voiceHoarseness1231738Partial
    9M0.92Rt. VC, uvulaHoarseness, weak cry, cyanosis, noisy breathingAsymptomatic641346Complete
    10M2Rt. VCHoarseness, dyspnea, stridorAsymptomatic72200Complete
    11M1.25Rt. pyriform, Rt. arytenoid, Rt. VC, uvulaHoarseness, dyspnea, cyanosisAsymptomatic541054Complete
    12M10Lt. VC, Rt. and Lt. false VCHoarseness, noisy breathing, apnea during sleepHoarseness6303Partial
    13F3Rt. and Lt. VC, ant. commissure, Rt. and Lt. arytenoid, interarytenoidHoarseness, noisy breathingHoarseness39905Persistent
    14F1.1Laryngeal surface of epiglottis, ant. commissure, Rt. ventricle, nasal vestibuleHoarsenessAsymptomatic144650Persistent
    15F2.3Ant. commissure, Rt. VC, Rt. and Lt. false VCAphoniaAsymptomatic12302Partial
    16F9Ant. commissure, Rt. and Lt. VC, Lt. false VC, Rt. ventricleHoarseness, dyspneaAsymptomatic121710Partial

    ID: identification, F: female, M: male, Ant.: anterior, VC: vocal cord, Rt.: right, Lt.: left, MT: middle turbinate

    • Table 2

      - Baseline data of included patients (N=16).

      Variablesn (%)
      Gender
      Male7 (43.8)
      Female9 (56.3)
      Age at diagnosis (year)3 (1.81-5.25)
      Total number of procedures6.5 (4.75-13.5)
      Length of follow-up (month)56 (12.8-97.8)
      Histology of tissue specimen
      Squamous papilloma11 (68.8)
      Squamous papilloma with HPV2 (12.5)
      Squamous papilloma with HPV P162 (12.5)
      Squamous papilloma, with HPV-6, and HPV-111 (6.3)
      Complications
      Anterior commissure adhesion1 (6.3)
      Disseminated RRP (pulmonary)1 (6.3)
      Extralaryngeal spread5 (31.2)
      Nasal vestibule1 (6.3)
      Posterior pharyngeal wall1 (6.3)
      Trachea1 (6.3)
      Uvula2 (12.5)
      Posterior glottic stenosis1 (6.3)
      None8 (50.0)
      First Derkay score17 (12-19.8)
      MTI0.215 (0.107-0.362)
      Patients treated with cidofovir12 (75.0)
      Patients treated with avastin10 (62.5)
      Change in Derkay’s score-11 (-13.3, -8.5)
      Clinical outcome
      Complete remission5 (31.3)
      Partial remission7 (43.8)
      Persistent disease4 (25.0)

      Values are presented as numbers and precentages (%) or median and interquartile range (IQR). HPV: human papilloma virus, RRP: recurrent respiratory papillomatosis, MTI: mean treatment intervals

      • Table 3

        - Univariate and multivariate regression results of the association between the change in Derkay score and other variables.

        VariablesUnivariate regressionMultivariate regression
        Regression coefficient95% CIP-valuesRegression coefficient95% CIP-values
        Gender (male)-2.25(-7.87, 3.36)0.404---
        Age at diagnosis in years-0.446(-1.25, 0.358)0.254---
        Length of follow-up in months-0.007(-0.06, 0.049)0.774---
        Histology of specimen (squamous papilloma)
        Squamous papilloma and HPV3.275(-4.914, 11.46)0.401---
        Squamous papilloma and HPV P167.773(-0.414, 15.96)0.061---
        Squamous papilloma, HPV-6, and HPV-110.273(-10.85, 11.4)0.958---
        Complication
        Extra-laryngeal spread-1.88(-8.44, 4.69)0.542---
        Posterior glottic stenosis-5.87(-18.08, 6.33)0.312---
        Anterior commissure adhesion-3.88(-16.08, 8.33)0.499---
        Disseminated RRP (pulmonary)-8.88(-21.08, 3.33)0.138---
        First Derkay score-0.424(-0.764, -0.083)0.018-0.337(-0.683, 0.009)0.056
        MTI-4.52(-18.4, 9.32)0.496---
        Patients treated with cidofovir (non treated)-5.83(-11.5, -0.143)0.045-4.008(-9.48, 1.46)0.138
        Patients treated with avastin (not treated)-1.13(-7, 4.73)0.685---
        Total number of procedures-0.151(-0.592, 0.29)0.476---

        CI: confidence interval, HPV: human papilloma virus, RRP: recurrent respiratory papillomatosis, MTI: mean treatment intervals

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