gms | German Medical Science

In aggressive forms of juvenile laryngeal papillomatosis permanent voice and breathing impairments are almost inevitable due to the high number of necessary papilloma debulking surgeries. Various adjuvant therapies such as immune stimulation with Interferon alpha, local application of Cidofovir, photodynamic therapy or even Mumps vaccination have been tried to lower the frequency of recurrences.

In 2006 the quadrivalent vaccine Gardasil against HPV types 6, 11, 16 and 18 became available. In Gynecology this raised new hopes to prevent the majority of cervical carcinomas in future. The vaccine is generally well tolerated. Its safety was questioned recently because of two unclear deaths in the USA (after two million vaccinations). This is observed by the FDA.

In an individual healing trial between January and August 2007 a two year old boy with rapidly recurring HPV 6 and 11-associated laryngeal papillomatosis was vaccinated with Gardasil. There were no complications. HPV in situ hybridisation in a biopsy of a small recurrence could not reveal any remaining virus copies. The clinical course improved considerably. If a complete remission has been achieved has to be shown over time.

Figure 1 [Fig. 1], Figure 2 [Fig. 2], Table 1 [Tab. 1]

Although preventive vaccinations of future mothers may reduce the number of juvenile laryngeal papillomatosis we still need a better treatment for our symptomatic patients. Vaccinations with Gardasil are unlikely to cure manifest HPV infections. However virus-neutralising antibodies may suffice to facilitate an earlier remission of disease. A multicentric trial should analyse the risk-benefit potential of Gardasil.