Updated Practice Patterns for Adjuvant Treatment of Recurrent Laryngeal Papillomatosis

Objectives: Adjuvant medical treatments are used to reduce recurrence rates of recurrent respiratory papillomatosis (RRP). Prior consensus statements on initiation of adjuvants may not reflect current practices, particularly given safety data published in the interval. The objective of this study is to distribute information on current practices in management of RRP, including the use of adjuvant medications, use of surgical modalities and other treatments, monitoring, as well as attitudes and philosophies. Study Design: Survey study. Setting: Email-distributed survey. Methods: A survey was distributed to a large group of laryngologists and pediatric otolaryngologists and responses were collected and analyzed. Results: Responses were collected from 86 surgeons, including 71 specific to adult patients and 16 specific to pediatric patients. Laryngologists reported a threshold of 2 surgeries per year to initiate intralesional adjuvant treatments, while pediatric otolaryngologists reported thresholds of 4 surgeries per year for intralesional bevacizumab and 5 surgeries per year for cidofovir. Variable responses between groups were reported for other factors leading to initiation of adjuvants, surgical tools used, practices around HPV vaccination and testing, monitoring, and attitudes and philosophies regarding treatment of RRP. Conclusion: Current practice patterns and attitudes reflect increased comfort with the initiation of adjuvant treatments earlier in the disease course. New medical treatments that promise a shift away from primarily surgical treatment are highly anticipated.