Literature Review: A Roundup of Important Recent Studies

Citation: Smith RV, Schiff BA, Sarta C, Hans S, Brasnu D. Transoral robotic total laryngectomy. Laryngoscope. 2013;123:678-682.

—Reviewed by Amy Eckner

Cidofovir Effective for Recurrent Respiratory Papillomatosis

Is cidofovir a safe, effective treatment for adult and pediatric otolaryngology patients with recurrent respiratory papillomatosis?

Background: Recurrent respiratory papillomatosis (RRP) is rare, and there is no known cure. Treatment consists of repeated surgical debulking of papillomata to improve symptoms. Cidofovir is beneficial for severe RRP, but this off-label use comes with a possibility of systemic toxicity. In January 2011, cidofovir’s manufacturer issued a general warning against off-label uses.

Study design: Cross-sectional study from an online survey.

Setting: Selected adult and pediatric laryngeal surgeons worldwide.

Synopsis: One hundred fifteen surgeons received a 21-question online survey; 82 surgeons, representing 3,043 RRP patients, responded. Respondents were asked to identify and rank specific clinical criteria to begin cidovofir treatment. Most respondents use a concentration of 5 mg/mL and administer <4 mL for adults, and a concentration of 5 mg/mL with administration of ≤ 2 mL for children. A majority of respondents use a set administration schedule, with a greater tendency toward scheduled administration for children. Respondents generally allow up to five injections to determine efficacy; there was no clearly preferred action for partial response. After a complete response, the majority of respondents stop cidofovir immediately. In adults and children, most respondents obtain biopsies routinely at each surgery, although this varies more with children. The most common adverse event in adults and children was squamous dysplasia. Despite the warning letter, most respondents indicated they would continue use of cidofovir for RRP. Because this study relied on respondents’ estimates, however, it cannot be compared to a true patient cohort, and the potential for recall bias disallows estimates of prevalence and incidence.

Bottom line: In general, cidofovir is recommended for RRP patients who require surgical debulking at least every two to three months.

Citation: Derkay CS, Volsky PG, Rosen CA, et al. Current use of intralesional cidofovir for recurrent respiratory papillomatosis. Laryngoscope. 2013;123:705-712.

—Reviewed by Amy Eckner

High-Volume Academic Medical Centers Have Lower Complication Rates for Head and Neck Oncologic Surgery

Do patient volume and other variables have an impact on outcomes of head and neck oncologic surgery?

Background: Study authors analyzed the University HealthSystem Consortium (UHC) database, a collection of patient-level UB-04 billing data from 90 percent of U.S. nonprofit academic medical centers, for patients who underwent head and neck surgery (except thyroid and skin cancer) at member centers between Q4 2006 and Q4 2009. Centers were designated high volume (> 50 cases/year), moderate volume (22-49 cases/year) and low volume (< 22 cases/year).