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Aktuelle Therapieoptionen bei der rezidivierenden respiratorischen Papillomatose

Current therapeutic options for recurrent respiratory papillomatosis

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Zusammenfassung

Diese Übersichtsarbeit soll den aktuellen Stand der therapeutischen Optionen bei der rezidivierenden respiratorischen Papillomatose (RRP) aufzeigen und die aktuellen Entwicklungen kritisch bewerten. Ziel jeder chirurgischen Therapie bei der RRP ist die Verminderung der klinischen Symptome, eine kurative Therapie ist nicht zu erwarten. Der CO2-Laser und der Microdébrider sind in der symptomatischen, operativen Therapie der RRP am weitesten verbreitet. Die Anzahl der Patienten mit RRP, welche eine adjuvante, antivirale Therapie erhalten, ist laut Literaturangabe in den letzten Jahren von 10 auf 22% gestiegen. Interferon, Cidofovir und Indol-3-Carbinol/Diindolylmethan (I3C/DIM) sind die am meisten verwendeten, adjuvanten Therapieformen der RRP. Das Fehlen von kontrollierten Langzeitstudien limitiert die Bewertung der adjuvanten Therapie. Sie sollten somit Patienten vorbehalten sein, bei denen die Chirurgie nicht ausreicht, um die Ausprägung der Erkrankung unter Kontrolle zu halten. Die Ergebnisse der immunologischen Forschung erlauben als Ausblick für die Zukunft, dass durch die Applikation von Vakzinen eine Immunsystemmodulation erreicht wird, die bessere Verlaufskontrollen der Erkrankung ermöglicht.

Abstract

The purpose of this review is to describe and to critically discuss recent advances in the management of recurrent respiratory papillomatosis (RRP). The goal of surgery in RRP remains the control of symptoms. A curative therapy cannot be expected. The microdebrider and the CO2-laser are currently the most widely used surgical options. Literature reports an increase in adjuvant medical therapies of 10–22%. The most common drugs in adjuvant therapy are interferon, cidofovir and indole-3-carbinole/diindolylmethane. The lack of controlled studies limits our ability to accurately assess the antiviral action of the adjuvant therapies. At the moment, therapeutic interventions remain focused on the surgical removal of papillomas when possible, and additional adjuvant therapy is available for the minority of patients for whom surgical management fails to adequately control their disease. Recent advances in immunologic research offer the hope of immune system modulation as potential future treatment modalities to better control this disease process.

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  1. Universitäts-HNO-Klinik Mannheim

    K. Huber, H. Sadick &  K. Götte

  2. Universitäts-HNO-Klinik Mannheim, Theodor-Kutzer-Ufer, 68135, Mannheim

    K. Götte

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  1. K. Huber
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  2. H. Sadick
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  3. K. Götte
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Correspondence to K. Götte.

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Huber, K., Sadick, H. & Götte, K. Aktuelle Therapieoptionen bei der rezidivierenden respiratorischen Papillomatose. HNO 53, 921–927 (2005). https://doi.org/10.1007/s00106-005-1323-1

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  • DOI: https://doi.org/10.1007/s00106-005-1323-1

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