Combining aminolaevulinic acid photodynamic therapy with carbon dioxide laser therapy to treat adult-onset laryngeal papillomatosis: case reports and a literature review

This paper describes 3 cases in which 5-aminolevulinic acid photodynamic therapy (ALA-PDT) was combined with carbon dioxide (CO2) laser therapy to treat patients with adult-onset laryngeal papillomatosis (ALP). Laryngeal papilloma is the most common benign laryngeal tumor, and is usually caused by human papillomavirus (HPV) types 6 and 11. It has the characteristics of rapid growth and frequent recurrence, and has a tendency of malignant transformation. Moreover, it can spread to the lower respiratory tract, which might lead to a rise in mortality risk. Laryngeal papilloma lesions are frequently found on the vocal cords or in the laryngeal cavity, and the characteristic koilocytosis is dispensable in pathological diagnosis of papilloma. Common symptoms include various degrees of hoarseness and wheezing. In the cases reported herein, all 3 patients suffered a recurrence of ALP following treatment. After the removal of the laryngeal papilloma using a combination of ALA-PDT and CO2 laser therapy, the patients were cured; there was no recurrence, and no further malignant transformation was found in the 6-12 months postoperative follow-up period. Our experiences show that ALA-PDT combined with CO2 laser therapy is feasible and effective in the treatment of ALP, and produces no obvious adverse reactions. However, further clinical trials need to be undertaken to confirm the efficacy of this treatment.