Abstract
Background: Recurrent laryngeal papillomatosis (RLP) is a benign but locally aggressive disorder of the larynx caused predominantly by human papillomavirus (HPV) types 6 and 11. Recurrent exophytic papillomas produce progressive dysphonia, airway compromise, and a need for repeated surgical debulking. Although microlaryngoscopic excision remains the standard of care, frequent recurrence and cumulative vocal-fold injury have prompted interest in anti-angiogenic adjuncts. Bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor, may reduce recurrence and improve functional voice outcomes. Objectives: To evaluate the efficacy and safety of combined intralesional and systemic bevacizumab therapy in adult RLP and to compare its clinical, functional, and safety outcomes with those of conventional microlaryngoscopic excision. Methods: This prospective comparative study was conducted at a tertiary care teaching hospital over 24 months. Sixty-seven adults with histopathologically confirmed RLP were allocated to combined intralesional and systemic bevacizumab (Group A, n = 36) or conventional microlaryngoscopic excision (Group B, n = 31). Disease extent was graded using the Derkay anatomical scoring system, and voice was assessed using the Voice Handicap Index-30 (VHI-30) and the GRBAS perceptual scale. Analyses were performed in IBM SPSS Statistics v26.0, with p < 0.05 considered significant. Results: Baseline characteristics were comparable between groups (p > 0.05). Bevacizumab was associated with faster voice recovery (8.5 ± 2.4 vs 18.6 ± 5.2 days; p < 0.001), shorter hospital stay (2.2 ± 0.7 vs 5.1 ± 1.3 days; p < 0.001), lower recurrence (11.1% vs 35.5%; p = 0.018), and fewer repeat interventions (13.9% vs 41.9%; p = 0.011). Post-treatment VHI-30 (18.5 ± 6.3 vs 31.4 ± 7.8) and GRBAS (2.4 ± 1.2 vs 4.3 ± 1.6) scores were significantly lower with bevacizumab (both p < 0.001). Excellent outcomes were achieved in 63.9% versus 35.5% (p = 0.028), and the overall complication rate was lower (27.8% vs 71.0%; p < 0.001). Conclusion: Combined intralesional and systemic bevacizumab demonstrated superior efficacy and a favourable safety profile relative to surgical excision alone, supporting its role as an organ-preserving adjunct in adult RLP. Multicentre randomised trials with longer follow-up are warranted to validate these findings and standardise treatment protocols.
Keywords: Recurrent laryngeal papillomatosis; Bevacizumab; Intralesional therapy; Vascular endothelial growth factor; Microlaryngoscopic excision; Voice Handicap Index; Disease recurrence.