Prolonged Treatment Gaps and Recurrence Patterns in Recurrent Respiratory Papillomatosis

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OBJECTIVES: Recurrent respiratory papillomatosis (RRP) is characterized by an irregular disease course, with recurrences after long periods of remission. New immunologic strategies are under investigation that aim to eliminate the chronic HPV infection. We evaluated recurrence patterns in RRP patients and sought to identify variables associated with prolonged remission periods. METHODS: Charts of all RRP patients seen since 2003 at our institution were reviewed. Surgical history and disease status in treatment-free intervals were evaluated. Patient and disease characteristics were compared using chi-squared and Fisher's exact tests in an exploratory analysis. RESULTS: Of 312 RRP patients, 71 (22.8%) experienced a treatment gap (TG) of at least 4 years between treatment and recurrence, with 43 (13.8%) having a TG over 10 years. TG patients did not differ from the remaining cohort in sex, juvenile/adult onset, or other clinical characteristics. To control for the possibility that TG patients resembled the entire cohort because of untreated occult disease, a subset was identified with prolonged (≥ 4 years) definitive remission. Compared to this remission group, TG patients were more likely to undergo surgery rather than office procedures before the gap in treatment (100% vs. 71.4% p = 0.003) and less likely to have supraglottic disease (17.5% vs. 57.1% p = 0.012). Other patient characteristics showed no significant differences. CONCLUSION: A substantial portion of RRP patients experience recurrence after prolonged treatment-free intervals, and this cohort cannot be easily predicted from available clinical characteristics. This highlights the need for effective immunologic strategies to eliminate the causative chronic infection.

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