Is multiple session of intralesional bleomycin mandatory for complete resolution of macrocystic lymphatic malformation?

Abstract

Background:Intralesional bleomycin scelro-therapy has become a favored line of treatment for macrocystic lymphatic malformations. However the need for multiple sessions is a drawback associated with this treatment modality. Our aim is to document whether multiple session of intra- lesional sclero-therapy is necessary for complete resolution of cystic lymphatic malformation.Method:Intralesional bleomycin under Ultrasound guidance was used for macrocystic lymphangioma at concentration of 3mg/ml but not exceeding the total dose (1mg/kg) body weight for single session or cumulative dose of 5mg/kg. In all cases intralesional sclerosant (ILS) was installed under proper aseptic precaution in operation theatre in general anesthesia or sedation depending on the site or size of lesion and age of the patient. Age of patients at the time of enrolment in study ranged from 3 months to 18 years. Clinical examination was the main stay of diagnosis which was supplemented by USG and/or computed tomography. Compression of the lesion site was done for few hours wherever it was possible after the ILS session.Result:A total of 21 patients included in our study. The age ranged from 3 months to 18 years. Male to female ratio was 8:13. The most common site of involvement was neck and axilla followed by anterior chest wall and nape of the neck. Complete resolution after single session was observed in 90.5% cases where as surgery was required in 9.5% case. Major complication was observed in one patient, who had intralesional bleeding which was managed conservatively. Transient pain and fever was observed in 23.8% of cases. Only two patient required surgical intervention where one had persistent subcutaneous fibrotic nodule and other one did not respond to ILS.Conclusion:Intralesional bleomycin is an effective treatment for macrocystic lesion, and complete resolution may be achieved by single session of ILS if proper principle are followed.

Effıcıency And Clınıcal Results Of Bleomısın Injectıon In The Treatment Of Lymphatıc Malformatıons

“…Injection of sclerosing agents is more effective in macrocystic lesions [4,13,14]. We had a patient with macrocystic LM in the anterior abdominal wall.…”

Management of macrocystic lymphatic malformation at uncommon site with aqueous bleomycin sclerotherapy

“…Since most of our patients come from low socioeconomic status bleomycin is also an economically viable alternative. Report of the intralesional aqueous solution of bleomycin is limited[ 13 14 ] though at our center we are using aqueous bleomycin with promising results. [ 15 ] The mode of action of belomycin in LM is the loss of secretory power caused by drug-induced inflammation on the endothelial lining rather than the killing of cells.…”

The Treatment of Lymphangiomas with Bleomycin in Childhood: A Retrospective Observational Study

“…Intralesional injection of bleomycin in the treatment of lymphangioma was first used in 1977 by Yura et al [13] Good results of bleomycin injection were reported in patients who had undergone previous surgery with incomplete resection and in patients with postoperative recurrence. Since then, many studies have been reported, and success rates have been reported varying from 35.7% to 91% for 'excellent response' and from 82% to 100% for 'good response' [14][15][16][17] . In the current study, an 'excellent response' to treatment was found in 55% of the cases and a 'good response' in 95% of the cases.…”