喉頭乳頭腫の臨床 －HPV感染とワクチン治療－

抄録

With the exception of a few cases that become cancerous, laryngeal papilloma is fundamentally a benign disease. At the same time, however, it is also a refractory disease that causes very serious impairments in respiratory and phonatory functions. Human papillomavirus (HPV), a cause of these papillomas, infects not only the site of the tumor, but also the surrounding laryngeal mucosa. Thus, recurrent laryngeal papillomatosis (RLP) is both a neoplastic disease and an infectious disease.

HPV-DNA tests for various laryngeal diseases were performed to investigate whether there was HPV infection of the larynx. All patients with non-neoplastic diseases were negative for HPV. In vocal cord leukoplakia and laryngeal cancer, HPV-31 was detected in 2 of 68 patients, but all others were negative. With papilloma, on the other hand, HPV-6/11 was detected at a high rate.

Treatment for laryngeal papilloma requires surgery for the tumor and treatment for the infection. Efforts are made to use low invasive surgery that does not leave postoperative scarring. Adjuvant therapy for RLP includes cidofovir, HPV vaccination, herbal medicine, and bevacizumab. In our hospital, combination therapy with HPV quadrivalent vaccine and surgery began in 2012, and it has been able to inhibit recurrences in 70% of cases of RLP. With this treatment method, anti-HPV antibodies are induced in the laryngeal mucus with vaccination, inhibiting re-infection with HPV. RLP treatments that aim for a complete cure with elimination of HPV from the larynx and resection of the tumor should be considered.