喉頭乳頭腫概説—2023年現在のトレンドを踏まえて—

<p>Recurrent respiratory papillomatosis (RRP) is a challenging disease that damages the quality of life of patients due to its repetitive nature and its disturbance of the patient’s airway and voice. Recent reports have revealed that its incidence has decreased with the increasing utilization of the quadrivalent and 9-valent HPV vaccine in several countries. Thus, prevention, leading to the elimination of RRP by increasing the vaccination rate is expected worldwide. The first step for the precise management of RRP is careful endoscopic evaluation of lesions in the squamociliary junctions of the upper airway, which are common sites of this disease. Image-enhanced endoscopy can clearly visualize the disease, with pathological examinations showing a central vascular core in each finger-like structure of the tumor. Office-based endoscopic laser surgery is often utilized in the surgical management of RRP. Recently, the advantages of the 445-nm blue laser, which possesses both cutting and photoangiolytic capabilities, in the office-based management of RRP have been reported. Medical treatment options, including anti-viral drugs, anti-angiogenic drugs, and the induction of anti-HPV immunity have been evaluated and have shown promising results. In particular, the systemic application of the anti-angiogenic agent Bevacizumab has shown a strong therapeutic effect, and could be a first-choice option for the treatment of advanced RRP. Furthermore, evaluations of DNA vaccines and PD pathway blockade as adjuvant therapeutic options are ongoing.</p><p>This review highlights the updated epidemiology, diagnosis, and therapy of RRP in the current era in which the eradication of this disease is underway with the expansion of HPV vaccination.</p>