Results of Injection Sclerotherapy with Bleomycin in Pediatric Lymphatic Malformations

Abstract

Aim: The aim of the study was to evaluate the results of injection sclerotherapy with bleomycin in pediatric patients with lymphatic malformations. Materials and Methods: In this prospective cohort study, all consenting pediatric patients with macrocystic lymphatic malformations were managed with injection bleomycin sclerotherapy (0.5 mg/kg, not exceeding 5 mg at a time) under ultrasound (US) guidance. After aspirating the cyst fluid bleomycin was instilled intralesionally in a ratio of 5:1 (aspirated cyst fluid volume: diluted bleomycin solution volume). Patients were reassessed at three weekly intervals. The response to therapy was assessed clinically as well as by size and volume on ultrasound Doppler study. The response was classified as excellent response, i.e., complete regression, good response >50% regression, and poor response <50% regression. Results: Sixty patients with lymphatic malformations were enrolled in the study, the mean age was 3.22 years, and the male-to-female was 2.5:1. The most common site of lesion was in the neck (43.3%), followed by the axilla (15%) and flank (8.3%). The responses were excellent, good, and poor in 43 (71.6%), 12 (20%), and five (8.3%) patients, respectively. Two patients underwent surgical excision of the residual lesion. Complications noted were fever in six, local pain in five, and residual lesion in three patients. Conclusion: Sclerotherapy with bleomycin is simple, safe, and effective in the first line of management for macrocystic lymphatic malformations in children.

Intralesional Bleomycin Sclerotherapy of Lymphangiomas in Children: Our Initial Experience

“…However, no life-threatening complications, such as respiratory obstruction and severe hypersensitivity reaction to bleomycin, were observed. The bleomycin doses used in sclerotherapy are small, in comparison to cytotherapeutic doses, which may be associated with pulmonary fibrosis (11). Although surgical excision has been considered to be the treatment of choice by most surgeons, it is associated with tedious dissection, along with a large amount of morbidity, in the form of disfigurement and damage to vital structures, and ugly scars.…”