Introduction
Recurrent Respiratory Papillomatosis (RRP) is a benign neoplasm of the respiratory tract associated with human papillomavirus (HPV) 6 and 111. Incidence is estimated at 4.3 in 100 0002. Patients present with hoarseness1–4, signs of airway obstruction3,4, and rarely malignant transformation may occur3. Surgical debridement is the mainstay of symptom management. Patients often undergo multiple surgical procedures3,4 that can result in complications such as vocal fold scar and laryngeal stenosis5.
Several adjuvant treatment options have been proposed to decrease the need for repeated surgical removal of tumors including intralesional cidofovir and bevacizumab. Mohr et al, 2014 first reported good or partial improvement with the use of systemic bevacizumab in five patients with RRP 4. In 2016, Zur and Fox described use of systemic bevacizumab in a 12 year old female with RRP3. In this case series we describe our experience treating three patients with juvenile onset RRP with systemic bevacizumab.