Rezidivierende respiratorische Papillomatose: Aktuelles zu Diagnose und Therapie

Die rezidivierende respiratorische Papillomatose (RRP) – ausgelöst durch das humane Papillomavirus (HPV) – ist durch warzenartige Veränderungen der Atemwege gekennzeichnet. Der klinische Verlauf ist variabel, die Diagnosestellung erfolgt nicht selten wesentlich später als der Symptombeginn, insbesondere bei Kindern. Die Behandlung wird individuell festgelegt und umfasst meist Operationen zur Tumorkontrolle und zum Erhalt der Stimmfunktion.

Kernaussagen

• Die rezidivierende respiratorische Papillomatose (RRP) ist eine durch humane Papillomaviren verursachte Erkrankung, deren Infektionsweg nicht zweifelsfrei geklärt ist.

• Man unterscheidet abhängig vom Lebensalter der Erstmanifestation die juvenile (JORRP) von der adulten (AORRP) Form, wobei erstere hochgradigere Verläufe aufweist.

• Der klinische Verlauf der Erkrankung ist sehr variabel und abhängig vom nachgewiesenen Virustyp.

• Grundlegendes Therapieprinzip ist die schonende chirurgische Abtragung zur Kontrolle der Erkrankung sowie zum funktionellen Erhalt des Atem- und Schluckwegs. Radikal-chirurgische Ansätze sind aufgrund der Viruspersistenz im umgebenden Gewebe nicht angezeigt.

• Eine medikamentös-adjuvante Therapie ist insbesondere bei schwergradigen Verläufen mit hoher Therapiefrequenz indiziert. Hierfür stehen verschiedene Medikamente zur Verfügung, welche jedoch weder für die Indikation zugelassen noch in kontrollierten Studien untersucht worden sind. Dennoch existieren hoffnungsvolle klinisch-experimentelle Untersuchungen, insbesondere für die Präparate Cidofovir und Bevacizumab.

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