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The objective of the present work was to evaluate the effectiveness of the application of the inducer of endogenous interferon synthesis in the course of the combined treatment of the adult patients presenting with laryngeal papillomatosis. A total of 50 patients with this pathology were admitted and examined at the ENT Clinics of I.M. Sechenov First Moscow State Medical University and M.F. Vladimirsky Moscow Regional Research Clinical Institute during 24 months. The patients comprising group 1 (n=25) were treated with the use of cold plasma surgery and the inducer of endogenous interferon synthesis while those included in group 2 (n=25) received only surgical treatment. It was shown that the combined treatment including the surgical step (cold plasma surgery) followed by the treatment with the inducer of endogenous interferon synthesis to prevent relapses makes it possible to reduce the number of secondary surgical interventions, increase the duration of the intervals between relapses, and decrease the content of types 6 and 11 human papilloma virus in the saliva.

The objective of the present study was to estimate the effectiveness and tolerance of propranolol therapy prescribed to the children presenting with vascular hyperplasia of the larynx. The experience with propranolol therapy of 12 patients suffering vascular hyperplasia of the larynx (subfold hemangioma) is analysed. Nine of these children had been given systemic glucocorticoid therapy prior to the present study that failed to produce a clinically significant effect. On the contrary, the treatment with propranolol resulted in a well apparent clinical effect in the form of the marked decrease in the size of subfold hemangioma and the reduction in the degree of laryngeal stenosis from grade 2-3 to 0-1 as early as 10-14 days after the onset of propranolol therapy at a daily dose of 2 mg/kg. None of the patients developed adverse reactions related to the treatment with propranolol. The results of the study indicate that the treatment of vascular hyperplasia, such as subfold hemangioma with the non-selective beta-blocker propranolol is both efficacious and safe for the patients. This gives reason to recommend this therapeutic modality as the first-line treatment of the children starting from the first weeks of life.

The objective of the present study was to estimate the justification of extended cervical lymphodissections and to evaluate the influence of adjuvant medicamental therapy in combination with the targeted treatment on the results of the management of oncological conditions. The 81 patients included in the study were allocated to the three groups. Group 1 was comprised of the patients (n=28) given neoadjuvant therapy and surgical treatment. Group 2 included the patients (n=27) undergoing the surgical treatment followed by remote gamma-therapy during the postoperative period. Group 3 consisted of the patients (n=26) receiving both the surgical treatment and targeted adjuvant medicamental therapy. The study has demonstrated that percent of wound complications after 2--3 courses of polychemotherapy in the patients of group 1 was higher by a factor of 5 in comparison with the patients of the two other groups. Wound healing by second intention was documented in 59% of the patients in group 1 and 10% of those in both groups 2 and 3. The five-year survival rate in the patients of group 3 was estimated at 38.5% (6.4 and 8.9% higher than in groups 1 and 2 respectively).

The objective of the present overview was to analyse the available data on etiology, pathogenesis, diagnostics, and treatment of laryngeal papillomatosis. It is shown that the pathogenetic mechanism underlying the development of this pathology is related to cell proliferation mechanisms. The human papilloma virus is most effectively identified by the polymerase chain reaction technique in combination with in situ hybridization. It is expected that new and more informative criteria for diagnostics, treatment,and prognosis of laryngeal papillomatosis will be proposed based on recent progress in molecular biology, morphology,and immunology. Different variants of the therapeutic strategy for the treatment of laryngeal papillomatosis are described.Modern practice of the management of laryngeal papillomatosis takes advantage of the three main approaches and/or their combination. First, further improvement of surgical techniques, such as the application of endoscopic devices and surgical lasers.Second, the search for new pharmaceutical agents (indole-3-carbinol, cidofovir, antiviral medicines, etc.) most frequently used for adjuvant therapy. Third, the development of new vaccination methods. Besides these three approaches, photodynamic therapy and the use of ionizing radiation are currently being studied as the tools for the treatment of extensive and recurrent laryngeal papillomatosis as well as the methods of laser-induced interstitial thermotherapy.

The objective of the present study was to estimate the possibilities and prospects for the use of regional intra-arterial chemotherapy in the combined treatment of locally advanced laryngeal cancer. The results of the chemoradiotherapeutic treatment of 26 patients presenting with locally advanced laryngeal cancer were analysed. The chemical agents were selectively administered intra-arterially three times from the right-hand femoral access by the standard procedure at a total focal dose (TFD) of 26 and 50 gram prior to the onset of and during of radiotherapy. The very first administration of the chemical agent resulted in the 30% decrease the tumour size. It further decreased by 70% on the average after the TFD of 50 gram was achieved. It made possible the continuation of gamma-therapy up to the total therapeutic dose. As a result, complete regression of the tumour was documented. The dynamic endoscopic control study and CT of the larynx revealed recurrent laryngeal cancer in 1 of the 26 patients (3.8%). The remaining patients did not develop metastases during the 18 month follow-up period. It is concluded that the results of the present study confirm high (96.2%) effectiveness of the method employed in this study which allows it to be recommended for the organ-preserving treatment of locally advanced laryngeal cancer.

A total of 384 children at the age ranging from 8 months to 17 years were admitted to the Russian Children's Clinical Hospital during the period between 1995 and 2009 for the treatment of juvenile respiratory papillomatosis. The overwhelming majority of the patients (n=242 or 63%) presented with the extensive lesions involving more than two segments of the larynx. 115 (30%) children had lesions in both the larynx and the trachea (including 4 (1.1%) ones with the affected bronchi and lungs). The laryngeal and tracheal neoplasms were removed with the help of microinstruments, such as tracheal forceps, under microscopic or endoscopic control. The combined treatment included therapy with roferon-A and ribavirin supplemented by interferon-alpha 2v. The duration of the treatment was 6 months in the least. It resulted in the almost two-fold lengthening of the periods between the relapses and the reduction of the extent of the pathological process. The outcome of the treatment was considered as positive (duration of remission 1 year or more) according to the currently accepted classification in 282 (73.4%) children.

Currently employed methods of tomographic diagnostics for the evaluation of effectiveness of the treatment of laryngeal and laryngopharyngeal cancer are described. The authors underscore that increasingly more attention tends to be given to magnetoresonance imaging (MRI) and especially X-ray computer tomography (CT) due to their wide application and high informative value whereas nuclear medicine techniques, such as single-photon emission CT using thallium-200, 11C-methionine and (18)F-positron emission tomography, are considered to be less important despite their great diagnostic potentialities. It is emphasized that X-ray CT with intravenous administration of contrast material should be regarded as the method of choice for the evaluation of larynx and pharynx conditions following treatment of their tumours. MRI should be reserved for patients in whom X-ray CT with contrast enhancement proves impracticable.

Patients with laryngeal cancer (LC) and premalignancy admitted to P.A. Gertsen Moscow Research Oncological Institute were treated by the methods of endolaryngeal surgery making use of flexible videoendoscopic devices, Nd:YAG laser-assisted thermal ablation, argon plasma coagulation, electroresection, and photodynamical therapy. A total of 129 patients were given treatment by these techniques following distant radiotherapy including 23 with grade I-III laryngeal dyskeratosis and dysplasia, 36 with virus-associated recurrent laryngeal papillomatosis, 37 with early cancer (Tis-T1NoMo) in the middle part of the larynx, 17 with a residual tumour, and 16 with mid-laryngeal cancer (T1-2NoMo). The above treatments resulted in complete regression (CR) of dyskeratosis and grade I-III dysplasia in 22 (95%) of the 23 patients and CR of recurrent papilllomatosis in 27 (75%) of the 36 patients. Moreover, complete regression was achieved in 34 (92%) of the 37 patients with laryngeal cancer. It recurred in 3 (9%) of the 34 patients. In all cases, the vocal function was completely restored. In groups with residual and recurring laryngeal tumours, complete remission was documented in 27 (82%) of the 33 patients. LC recurred in three patients within 1-5 years after completion of the treatment.

Clinical-immunological examination of 41 patients with recurrent respiratory papillomatosis (RRP) included determination of phenotype CD3, CD4, CD8, CD16, CD25, CD56, HLA-DR in peripheral blood by flow cytofluorimetry, the levels of IFN-gamma, TNF-alpha, GM-CSF, IL-2, IL-4, IL-5, IL-10, IL-12, IL-13 in the laryngeal secretion by multiplex immunoassay. Interferon inhalation therapy was conducted to prevent recurrence in 23 patients after surgical treatment and in 18 patients as monotherapy. The efficacy of the monotherapy was 45.5%. Treatment with IFN-alpha raised the levels of cytokines modulating an immune response by Th1-type (IFN-gamma, IL-12, IL-2) and GM-CSF, and reduced the levels of IL-4, IL-10 and IL-13. Local treatment with recombinant IFN-alpha is effective in aggressive RRP. As prognostic markers of the treatment efficacy may serve baseline high levels of TNF-alpha and IL-4/IFN-gamma index in laryngeal secretion. Treatment efficacy can be assessed by raise of IFN-gamma, IL-2 and IL-12 in combination with reduction of IL-4/IFN-gamma index.

The study of indinol efficacy in antirecurrence therapy of respiratory papillomatosis was performed in 46 children aged 2-14 years. The treatment lasted at least 12 weeks. Duration of a recurrence-free period before and after indinol administration was analysed. The response was observed in 30 (65.2%) patients. In 5 (10.9%) patients the remission continued from 2 to 3 years 10 months. In 25 (54.3%) patients recurrence-free period increased 1,5-6-fold. Side effects were not registered. Simple in use, cheap, well tolerated, usable with other treatments, indinol is recommended as a method of choice in antirecurrence treatment of recurrent respiratory papillomatosis.

Seventy three patients aged 16 to 88 years who had laryngeal papillomatosis (LP) were followed up. Microsurgical endolaryngeal removal of laryngeal papillomas was made in all the patients. The interferon inducers amixine and cycloferon as antirecurrent drugs were used in 45 patients by the regime the authors developed by taking into account the interferon status and cellular immunity of patients. The criteria for the efficiency of treatment were their improved interferon status and longer remission. The efficiency of treatment with amixine and cycloferon was 72 and 80%, respectively. Thus, the use of a sparing microsurgical intervention in combination with interferon inducers may be regarded as the method of choice in the LP treatment.

Formation of neutralizing antibodies (NAB) to alpha-interferon (aINF) was assessed in the reaction of antiviral activity neutralization in 36 children with severe juvenile respiratory papillomatosis (JRP). Surgical removal of papillomas was combined with administration of recombinant aINF preparations (reaferon, intron A, viferon). High and moderate neutralizing activity was determined in 22 (61.1%) patients. 7, 2 and 13 of them received reaferon, intron A and viferon, respectively. NAB were not registered in the rest 14 (38.9%) patients. The frequency of NAB formation was not related to the preparation used, only in the group on reaferon it was insignificantly higher. It was found that the highest response to therapy occurred in children with low NAB titer (8 of 12 children, 66.7%), while children with high NAB titer (3 of 4 children, 75%) did not respond.

Identification of the type of human papilloma virus (HPV) was done by means of polymerase chain reaction in 40 children with juvenile respiratory papillomatosis (JRP). Adjuvant to surgery interferon treatment was carried out in 18 patients (study group) with severe JRP. The rest 22 patients (control group) with less severe papillomatosis received only surgical treatment. The majority of the patients from both the groups had the virus type 6/11 (72.2 and 77.3% for the study and control groups, respectively). The assessment of a relationship between HPV type and effectiveness of interferon treatment in the study group has shown that the share of patients with effective and uneffective interferon therapy in each category (by HPV type) was about the same, i.e. no correlation exists between HPV type and interferon therapy effectiveness.

Basing on the results of long-term observational study of 200 patients with laryngeal papillomatosis the authors made a conclusion on cycle pattern of the disease course. Each cycle consists of two periods: active (rapid growth of the tumor) and passive (slow growth of the tumor, recurrences are rare, 1-3 years of remission). A case of a male patient is reported illustrating cycle course of transitional laryngeal papilloma. In the beginning of the third cycle, in active period, his papilloma underwent malignant transformation. Cryotherapy of papilloma is thought ineffective.

To improve the outcomes of surgical or combined treatment of patients with laryngeal cancer stage III-IV in terms of preventing the recurrences and metastases, the authors placed biocompatible polymer material saturated with cytostatic in the operative wound in the end of the surgical intervention. The response assessed in 107 patients with laryngeal cancer treated with prospidin on polymer film (20 cases) versus 87 prospidin-untreated controls was more positive in the test group (5-year survival was higher).

Original immunological studies allowed the authors to design a combined treatment of laryngeal papillomatosis (LP) with administration of immunomodulators and cytostatics. Surgery was performed on demand. Thymic hormone preparation (T-activin, thymalin, thymogen) and prospidin served as immunomodulators and cytostatic, respectively. To create lymphotropism, prospidin was delivered by means of electrophoresis following subcutaneous introduction of 8--16 U lidase. Sensitivity of patients to thymalin was tested in vitro by thymalin-induced changes in the number of CD2--DR+ lymphocytes. Adjuvant modalities were age-adjusted dibasol as inductor of interferon genesis and adaptogens (eleutherococcal fluid extract, B and C vitamins). Such treatment was given to 39 children. Remission duration increased 1.6--2.6-fold, 6 of 7 children with primary LP achieved persistent remission. Positive changes in immunological indices occurred in 84% of children. The above treatment outcomes support the efficacy of the method in childhood LP.