Office-based 532-nm KTP laser as a therapeutic modality for recurrent laryngeal papillomatosis: efficacy and relative factors.

This study aims to investigate the efficacy of office-based potassium-titanyl-phosphate (KTP) 532-nm laser in the management of recurrent laryngeal papillomatosis (RLP) following other treatments. A retrospective assessment was performed on 55 patients in 259 cases of RLP between 2012 and 2019. Derkay scores were obtained for all patients who underwent 532-nm KTP laser procedure (6 W of power with a continuous output mode) prior to treatment and after treatment. Analysis of parameters is based on the distribution characteristics of data. An ordinal logistic regression was also performed. Patients received a median of 3 (range 1-24) office-based KTP laser treatments. Among them, 96.36% (53 patients) were previously on cold steel equipment, CO2 laser, or microdebrider treatment under general anesthesia, and all previous treatments on them had failed. One patient progressed to invasive cancer, so he was excluded from the following analyses. After final KTP treatment, 36 patients (66.67%) received complete resolution with follow-up time ranging from 12.9 to 80.53 months (median 55.54 months). Results of subjective voice-quality indicators such as VHI-30 and GRBAS all improved greatly at the last follow-up. The initial Derkay scores and treatment intervals were found to be predictive of complete lesion remission. Arytenoid involvement may also correlate with lesion resolution. Serial office-based KTP treatment is an effective option for RLP patients, with ideal disease control and voice quality preservation. KTP laser therapy should be repeated with an interval of 1 month from the beginning of treatment until the lesion has been evaluated and subsided. Non-bulk or scattered laryngeal papilloma is an appropriate indication for KTP laser treatment.

The Role of Adjuvant Radiotherapy in the Treatment of Papillary Tumors of the Pineal Region: Some General Considerations and a Case Report.

BACKGROUND: Papillary tumor of the pineal region (PTPR) is a recently defined tumor entity. Its clinical course is characterized by frequent local recurrence, and patients may experience the burden of symptoms due to the anatomical location of the growing mass. Guidelines for treatment protocols, and the role of radiotherapy are still being investigated. CASE: We report the case of a 27-year old woman who was referred to our department after she was diagnosed with PTPR and had undergone multiple surgical interventions. We delivered adjuvant conformal radiotherapy on the gross residual tumor to a total dose of 59.4 Gy (33 × 1.8 Gy). DISCUSSION: After a follow-up period of 41 months, we obtained a complete response to the treatment, according to the Response evaluation criteria in solid tumors criteria (RECIST). Radiation treatment was well tolerated, and the patient did not develop acute and late side effects. The neurological symptoms, which were documented at the diagnosis and after the surgical procedure, have not been recorded at last follow-up. CONCLUSIONS: Formal consensus for managing patients with a diagnosis of PTPR are nonexistent. Despite surgery, this tumor has a tendency to recur. Radiotherapy could have a role in the adjuvant setting and needs to be investigated in a multicenter setting with a long follow-up.Key words: radiotherapy - neurosurgery - magnetic resonance - pineal region - brain tumor.

Oncocytic Schneiderian Papilloma of the Sinonasal Tract Treated With Radiotherapy.

A 66-year-old man visited the ophthalmology department due to epiphora and was subsequently diagnosed with oncocytic schneiderian papilloma. Surgical removal was recommended to the patient; however, he refused this option. Therefore, a radiation of 64 gray (Gy) was administered in 32 daily doses (2 Gy daily) over 45 days using intensity-modulated radiotherapy. Four months after radiotherapy, the tumor had disappeared. Two years postradiotherapy, the patient was healthy, without tumor recurrence or the development of orbital complications. The authors suggest that radiotherapy could be an adjuvant or definite treatment modality for patients of oncocytic schneiderian papilloma unsuitable for complete surgical removal, or those associated with a high risk of surgery-related complications.

Curing a Patient of Recurrent Tracheal Papillomatosis Using Laser Ablation and Adjuvant Radiotherapy.

We present a 28-year-old man with an early onset of recurrent respiratory papillomatosis at 1 year. The patient had undergone 31 operations over a period of 7 years. After the diagnosis of tracheal papillomatosis, he received a four-time treatment of T-tube insertion combined with laser fulguration. During the last operation, pathologic findings showed moderate dysplasia with malignancy potential. Conformal radiotherapy was then given at 5000 cGY, targeting the tracheal tumor bed. The patient experienced complete remission with no complications. His condition has lasted for 20 years, and has continued up through the time of this report.

[Treating papillomatous intradermal nevi: lasers - yes or no? A prospective study]. / Management papillomatöser intradermaler Nävi: Laser ja oder nein? Eine Prospektivstudie.

BACKGROUND: Papillomatous intradermal nevi are common acquired melanocytic nevi. Although harmless, they can be - especially on the face - cosmetically disturbing. At selected sites on the trunk, they may be traumatized by clothing, so that patients often wish to have them removed with a low likelihood of recurrence. MATERIAL AND METHODS: In a prospective study with 90 (female symbol=77, male symbol=13) patients aged between 13 and 67 years, 130 intradermal nevi (female symbol=114, male symbol=16) were removed using a combined therapy with CO(2), erbium: YAG and ruby lasers. RESULTS: After therapy, 2.3% of intradermal nevi recurred as a pigmented macule, while 6.9% reappeared as a papule or nodule (volume recurrence). 88% of the patients were very satisfied with the result; 11%, satisfied; and 1%, not satisfied. 99% would undergo the therapy again. CONCLUSION: The combined laser method (CO(2), erbium: YAG and ruby lasers) for the treatment of intradermal nevi produces excellent cosmetic results, is easily performed, leads to high patient satisfaction and is safe if correctly applied.

Papillary tumor of the pineal region--a new pathological entity.

Papillary tumor of the pineal region has recently been proposed as a new, distinct clinicopathological entity. On the basis of the immunophenotypic and ultrastructural properties of these lesions, origin from specialized ependymocytes of the subcommissural organ was postulated. We present the third publication on a papillary pineal tumor and describe the morphological, immunohistochemical and ultrastructural features of this neoplasm. The patient was a young woman who presented with signs of raised intracranial pressure and Parinaud syndrome. Magnetic resonance imaging revealed a neoplastic lesion in the pineal region. She underwent surgical resection of the tumor through a midline infratentorial-supracerebellar approach. Papillary tumor of the pineal region represents a new, distinct clinicopathological entity. The differential diagnosis, possible histogenesis and management of these lesions are discussed.

[Radiowave surgery for epibulbar tumor and nontumor masses].

The paper analyzes the results of removal of epibulbar tumor and nontumor masses, by using the radiowave surgical technique. The authors used two basic modes: fulguration and completely rectified and/ or completely filtered wave. Postoperative healing was aseptic and areactive. The duration of reparation depended on the working conditions, the volume of excised tissues, and the individual pattern of reparative processes. No intraoperative and postoperative complications were found. There were no cases of relapses and on-going growth during 9-12-month follow-ups. The authors have concluded that a radiowave knife may be used in surgery for epibulbar tumor and nontumor masses.

The role of radiation therapy in inverted papilloma of the nasal cavity and paranasal sinuses.

Between December 1969 and March 1985, seven patients with advanced biologically aggressive inverted or cylindrical cell papillomas were treated with irradiation at the University of Florida. Three patients were treated with radiation therapy alone, and four patients were irradiated either before (one patient) or after (three patients) resection. No recurrences were observed in six patients at 4.5, 7, 8, 8, 9, and 20 years following treatment (including two who died of intercurrent disease at 7 and 9 years after radiation therapy without evidence of recurrent tumor). One patient treated with irradiation alone for an advanced recurrent papilloma developed a local recurrence extending into the frontal lobe of the brain and died 17 months after radiation therapy. None of the patients experienced a significant complication of irradiation. Although surgery is generally the primary treatment modality for this disease, radiation therapy should be considered for patients with advanced, incompletely resected, or unresectable lesions.

Management of inverted papilloma of the nasal cavity and paranasal sinuses: importance of radiation therapy.

PURPOSE: Locally advanced inverted papilloma and inverted papilloma associated with squamous cell carcinoma are at high risk of local failure due to limitations of surgical resection resulting in repeat surgical procedures. The role of adjuvant radiation therapy is poorly defined. This study reviews a single institution experience of radiation therapy in the management of this disease. METHODS AND MATERIAL: Between 1977 and 1990 25 patients were treated at the Massachusetts General Hospital and the Massachusetts Eye and Ear Infirmary with radiation therapy for inverted papilloma (seven patients) and inverted papilloma associated with squamous cell carcinoma (18 patients) of the nasal cavity and paranasal sinuses. All patients presented with locally advanced invasive tumors; 5 of 7 with inverted papilloma had previous resections and 4 of 18 with associated squamous cell carcinoma had history of prior surgical excisions of inverted papilloma only (three patients) or inverted papilloma with squamous cell carcinoma in situ (one patient). Sixteen patients underwent radiation treatment following gross total resection, eight patients after subtotal tumor resection and one patient was inoperable by local invasion and received radiation therapy alone. RESULTS: Local control was achieved in 6 of 7 patients with inverted papilloma only and one patient required additional resection for persistent disease. Of 18 patients with associated squamous cell carcinoma, 17 were locally controlled after radiation therapy and one had persistent tumor. One patient failed locally 3 years after treatment. With a mean observation time of 4.8 years (range: 0.5-12.9 years) all seven (100%) patients with inverted papilloma only and 15 of 18 (83%) patients with associated invasive carcinoma are alive and without evidence of disease. Three patients with inverted papilloma associated with squamous cell carcinoma died, two patients as a result of their disease (one patient with persistent disease, one patient after local failure) and one patient of intercurrent disease. No failure in either regional lymph nodes or at distant sites was recorded. In the majority of cases radiation therapy was well-tolerated. CONCLUSIONS: Combined radiation therapy and surgery can offer excellent long-term control and should be considered in patients with history of recurrent disease, in the presence of suspected residual disease, after incomplete resection or for unresectable lesions. Patients with associated squamous cell carcinoma have a more aggressive course, however radiation therapy still has the prospect of permanent disease-free survival in patients who achieve local control.

Radiotherapy for inverted papilloma: a case report.

Inverted papilloma is an infrequent tumour of the nasal cavity and paranasal sinuses associated with controversy. The incidence of carcinoma in situ associated with inverted papilloma, has not been very well documented until now. Therefore, we present a case report characterized by an aggressive clinical behaviour, treated by extensive surgery and ultimately controlled by radiotherapy.

Choroid plexus papillomas: long-term follow-up results in a surgically treated series.

The medical records and histological specimens from 26 patients with choroid plexus papillomas operated on at one institution were reviewed retrospectively. Four patients died perioperatively, and 21 of the remaining 22 patients were followed through March, 1986; the patient lost to follow-up review was last seen 14 years postoperatively. Of the 14 patients who underwent gross total removal of their tumor, one had a recurrence at 11 years postoperatively and two died in the perioperative period. Of the 12 patients who underwent subtotal removal of their tumor, two died in the perioperative period. The two patients who did not have radiation therapy postoperatively are free of apparent disease at 6 and 8 years after their operation. Eight patients underwent radiation therapy after subtotal removal of their tumor; four of these remain alive and well, and four have died of progressive disease. The role of irradiation in the treatment of subtotally resected lesion remains controversial, but this therapy is thought to be indicated for recurrent disease after a surgical excision that is as complete as possible. Histopathologically, the presence of occasional mitotic figures, microscopic infiltration, ependymal differentiation, or mild to moderate atypia was not correlated with likelihood of complete resectability or tendency to recurrence.

Bilateral cavernous malformations resulting from cranial irradiation of a choroid plexus papilloma.

We report a case of multiple parietal cavernous malformations in a thirteen year old female who received cranial irradiation following incomplete resection of a choroid plexus papilloma. The cavernous malformations, which developed within the prior parietal radiation ports, were diagnosed nine years after the patients' radiation treatment when the patient presented with increasing frequency of seizures. Family history was negative for familial cavernous malformations. Due to the worsening frequency of seizures, the patient underwent resection of these two cavernous malformations with diagnosis confirmed by pathology. Post-operative, there was a significant reduction in seizure frequency. The origin and pathophysiology of cavernous malformations remains controversial. Cranial radiation treatment for tumors, particularly in children, may possibly lead to the development of these lesions, as occurred in this case. This is, to our knowledge, the first case of multiple cavernous malformations occurring within a previous radiation field following radiotherapy for a neoplasm.

Biologically aggressive papillomas of the nasal cavity: the role of radiation therapy.

Five patients were irradiated at the University of Florida for advanced and/or recurrent papillomas of the nasal cavity and paranasal sinuses from December 1969 through December 1981. Three patients were irradiated either before or after resection and two patients were treated with radiation therapy alone. Two patients had pure inverted papilloma, one patient had inverted papilloma associated with a focus of squamous cell carcinoma, and two patients had cylindrical cell papillomas. Four patients are alive and continuously disease free at 3, 3, 4, and 11 years following treatment. One patient died of intercurrent disease nine years following treatment without evidence of recurrent tumor.

Carcinoma ex-papilloma: histologic and virologic studies in whole-organ sections of the larynx.

A patient with adult-onset recurrent respiratory papillomatosis (RRP), initially diagnosed at age 28 years, was treated with radiation therapy due to the rapid regrowth of lesions. Following 6 years of apparently inhibited growth, papilloma recurred, and squamous carcinoma was diagnosed from a laryngeal biopsy. A spontaneous laryngocutaneous fistula developed, and laryngectomy was performed 14 years after irradiation. The laryngectomy specimen was snap frozen and representative tissues were stored frozen for viral studies. The larynx was whole-organ sectioned for histologic examinations; residual papilloma, as well as carcinoma, was observed. Koilocytosis and other virus-associated histologic changes were also found. HPV capsid antigen was present in papilloma, carcinoma, and clinically normal epithelium. HPV nucleic acids, conforming to HPV type 6, were present in keratin pearls and dysplastic cells. According to prior reports, carcinoma developing in preexisting papilloma arises from juvenile-onset RRP. Irradiated papilloma develop cancer at about 10 years, and the patients rarely survive. Nonirradiated cases develop cancer after 30 years, and some develop papilloma in the hypopharynx and trachea, but most patients survive. Irradiation is not an obligatory precursor for malignant transformation of cancer; however, until now there have been no case reports of favorable outcome after irradiation of papilloma.

Different options for treatment of inverting papilloma of the nose and paranasal sinuses: a report of 41 cases.

Forty-two cases of inverting papilloma of the nose and paranasal sinuses were reviewed from 1972 to 1989. Forty-one patients underwent surgical excision. Of those patients followed up for at least 6 months, lateral rhinotomy was performed in 14 patients and midfacial degloving in 9 patients. The recurrence rates were 29% and 22%, respectively. The other 10 patients underwent excision through an external ethmoidectomy, Caldwell-Luc operation, or intranasal approach. There were five patients (12%) diagnosed with squamous cell carcinoma associated with inverting papilloma. The correlation of malignancy with proptosis, visual changes, infraorbital hypesthesia, and skull base involvement on presenting symptomatology is noted. Inverting papilloma is a benign neoplastic lesion that shows variable aggressiveness. A computed tomography (CT) scan evaluation is very important for the work-up. An aggressive wide surgical excision is best performed through an open approach. The approach for surgical removal should be based on the location and extension of the lesion. A graduating approach from a lesser to a more major excision is advocated even though a risk exists of having to reoperate in about one fifth of the patients who experience a recurrence. A secondary surgical excision, even with craniofacial resection, is essential to eradicate disease in cases of recurrence. Close follow-up is necessary. Further surgery may be indicated. Post-operative radiation therapy is recommended if malignancy is indeed present.

The role of radiation therapy in the treatment of recurrent adult laryngeal papillomatosis.

Laryngeal papillomatosis is an uncommon condition in the adult, but it can be severe enough to require tracheostomy for obstructive changes following multiple recurrences, despite surgical local excisions and medical therapies. Few satisfactory treatments are available for such cases to restore both airway function and speech. Some patients may require laryngectomy for progressive dysfunction. The role of radiation therapy has been controversial, with some reports of malignant transformation following treatment. The authors describe two cases treated with irradiation, resulting in complete clearance of the lesions and return of airway and vocal function. Follow-up is given, and the available literature is reviewed.

585-nm pulsed dye laser treatment of glottal papillomatosis.

Treatment of recurrent respiratory papillomatosis of the glottis is often challenging. The surgeon and patient must cooperatively balance decisions regarding airway safety, effects of multiple general anesthesias, employment disturbance, and vocal dysfunction. A pilot study was done in 41 adult cases (23 patients; 78 vocal folds) without complication to evaluate the effectiveness of a 585-nm pulsed dye laser (PDL; 450-micros pulse width; fluence of 38 to 255 J/cm2; 1- to 2-mm spot size) in the treatment of this disorder. Thirty-seven of the 41 cases (90%) were bilateral disease. Twenty-six of the 41 cases (63%; including 20 cases with involvement of the anterior commissure) were treated by bilateral photocoagulation of the lesions' microcirculation without microflap resection of tissue. Clinical observation revealed that irradiated but unresected disease involuted without development of an anterior commissure web. In the initial 13 of the 41 cases (32%), PDL treatment was followed by cold instrument microflap resection. The PDL enhanced the epithelial excision by improving hemostasis and by creating an optimal dissection plane between the basement membrane and the underlying superficial lamina propria. The PDL at 585 nm was less effective in the management of exophytic lesions because of its limited depth of penetration (approximately 2 mm). In this initial trial, the PDL was a relatively safe and efficacious treatment for glottal recurrent respiratory papillomatosis. Since the lesions involute without complete resection of the diseased epithelium, the anterior commissure can be treated to minimize the number of procedures. To study patterns of recurrence will require longer follow-up.

Reduction of papilloma size by ultraviolet irradiation in the Japanese newt, Cynops pyrrhogaster.

Experiments were conducted on 44 captive Japanese newts (Cynops pyrrhogaster) to test the hypothesis that ultraviolet (UV) irradiation might inhibit growth or induce regression of spontaneous skin papillomas of probable viral origin. An empirically derived exposure to UV irradiation (42 microW per cm2 per day) induced reduction of papilloma size which began approximately 4 weeks after irradiation was initiated. This regression included histological evidence of tissue vacuolization and cellular necrosis of papillomatous epithelium. These findings, taken together with previous data on seasonal, temperature and geographical influences on papilloma prevalence, lend support to the notion that solar UV radiation may modulate papilloma prevalence in the natural environment, possibly by direct effects on viral infection.