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Doxycycline sclerotherapy in children with head and neck lymphatic malformations
1Division of Pediatric Otolaryngology, Cohen Children's Medical Center, New Hyde Park, NY, USA; Department of Otolaryngology-Head and Neck Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
Insights
Doxycycline sclerotherapy (DS) is a highly effective treatment for pediatric head and neck lymphatic malformations, achieving an 84.2% success rate. This safe and inexpensive method showed no correlation with patient factors for successful outcomes.
Area of Science:
- Pediatric Otolaryngology
- Vascular Anomalies
- Sclerotherapy
Background:
- Lymphatic malformations are congenital vascular anomalies that can affect the head and neck in children.
- Treatment options for pediatric head and neck lymphatic malformations are varied, with sclerotherapy being a common approach.
- Doxycycline sclerotherapy (DS) has emerged as a potential treatment modality, but its efficacy and associated factors require systematic evaluation.
Purpose of the Study:
- To systematically review the literature on doxycycline sclerotherapy (DS) for treating pediatric head and neck lymphatic malformations.
- To examine patient-specific factors that may be associated with successful treatment outcomes using DS.
- To assess the overall effectiveness and safety profile of DS in this pediatric population.
Main Methods:
- A comprehensive literature search was conducted across PubMed, EMBASE, and Ovid databases from 1995 to 2014.
- Studies focusing on doxycycline sclerotherapy as the primary treatment for pediatric head and neck lymphatic malformations were included.
- Successful treatment was defined as clinical symptom resolution or >50% radiographic reduction; patient factors were analyzed for correlation with success.
Main Results:
- Five retrospective case series studies met the inclusion criteria, all with a high risk of bias.
- Thirty-eight pediatric patients with head and neck lymphatic malformations were analyzed.
- Doxycycline sclerotherapy achieved an overall success rate of 84.2% (32/38), with 60.5% (23/38) requiring only one treatment session. No patient factors (age, gender, de Serres stage, malformation type) predicted treatment success.
Conclusions:
- Doxycycline sclerotherapy is a highly effective treatment for macrocystic and mixed pediatric head and neck lymphatic malformations.
- DS offers advantages such as low cost, wide availability, and minimal side effects compared to other sclerosing agents.
- Current evidence suggests that patient characteristics do not predict treatment success with DS for these conditions.
Objective:
This is a systematic review of the literature describing doxycycline sclerotherapy (DS) to treat pediatric head and neck lymphatic malformations and examine patient factors associated with treatment success.
Data Sources:
PubMed, EMBASE, and Ovid.
Review Methods:
A query of PubMed, EMBASE, and Ovid search engines (1995-2014) for studies examining outcomes for doxycycline sclerotherapy (DS) as primary treatment strategy for children with head and neck lymphatic malformations was undertaken. Successful outcome was defined as clinical resolution of symptoms or greater than 50% reduction in radiographic involvement.
Results:
Five studies met the inclusion criteria for review. All were retrospective case series reports with high risk of bias. The dose of doxycycline used in all but one of the studies was 10mg/mL, and the highest concentration administered was 20mg/mL. Thirty-eight children met the inclusion criteria for analysis. Thirty-two (84.2%) children were successfully treated with DS, with 23 (60.5%) utilizing only one treatment session. Average follow-up was 9.7months. Age, gender, de Serres stage 1, and type of lymphatic malformation were not related to successful treatment outcome (p=0.23, 1, 1, and 0.13, respectively).
Conclusions:
DS is very effective for treatment of macrocystic and mixed head and neck lymphatic malformations in children. Overall success with DS treatment in children with lymphatic malformation of the head and neck was 84.2%. DS has distinct advantages over other sclerotherapy agents including that it is inexpensive and widely available, and has minimal side effects. No associated patient characteristics were found to predict improved success.
