Doxycycline Sclerotherapy Is Superior in the Treatment of Pediatric Lymphatic Malformations
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Published on: May 1, 2015
Debi M Thomas1, Minna M Wieck1, Christa N Grant1
1Departments of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.
Insights
Doxycycline sclerotherapy is more effective than sodium tetradecyl sulfate (STS) for treating pediatric lymphatic malformations (LMs). Doxycycline offers excellent outcomes with fewer treatments and less need for surgery.
Area of Science:
- Pediatric Surgery
- Vascular Anomalies
- Interventional Radiology
Background:
- Lymphatic malformations (LMs) are congenital vascular anomalies.
- Macrocystic and mixed LMs often require treatment to improve quality of life.
- Sclerotherapy is a common treatment modality for LMs.
Purpose of the Study:
- To compare the efficacy of doxycycline sclerotherapy versus sodium tetradecyl sulfate (STS) for treating pediatric macrocystic and mixed lymphatic malformations.
- To evaluate treatment outcomes, including response rates and need for subsequent surgery.
Main Methods:
- Retrospective review of 41 children treated with doxycycline or STS for macrocystic/mixed LMs.
- Analysis of clinical response (excellent/moderate defined as >90% or >50% LM resolution).
- Comparison of treatment parameters including number of sessions and follow-up duration.
Main Results:
- Doxycycline achieved excellent/moderate response in 87% of patients versus 55% with STS (P = .03).
- Fewer patients treated with doxycycline required subsequent resection compared to STS.
- Average treatment sessions were similar, but STS had longer follow-up periods.
Conclusions:
- Doxycycline monotherapy demonstrates a high success rate for pediatric macrocystic and mixed LMs.
- Sclerotherapy with doxycycline is a safe and effective primary treatment option.
- Doxycycline offers superior clinical outcomes compared to STS for these conditions.
Purpose:
To evaluate efficacy of sclerotherapy with doxycycline versus sodium tetradecyl sulfate (STS) for treatment of macrocystic and mixed lymphatic malformations (LMs).
Materials And Methods:
This single-center retrospective review identified 41 children (17 boys; 24 girls; age range, 1 month to 15.4 y) who underwent sclerotherapy with doxycycline (n = 32) or STS (n = 9) for macrocystic (n = 31) or mixed (n = 10) LMs. There were 114 treatments performed, averaging 2.8 treatments (range, 1-8 treatments) per patient. Average follow-up time was 10 months (range, 1-59 months). Clinical response was deemed excellent or moderate if > 90% or > 50% of LMs resolved based on visual estimate.
Results:
With doxycycline, 87% of patients (28 of 32) had excellent or moderate response with an average of 2.8 treatments (range, 1-7 treatments); 13% required subsequent resection. With 3% STS monotherapy, only 55% of patients (5 of 9) had excellent or moderate response with an average of 2.8 treatments (range, 1-8 treatments), and 33% required subsequent resection. Significantly fewer patients treated with STS responded well compared with patients treated with doxycycline (P = .03). Patients treated with STS had significantly longer follow-up than patients treated with doxycycline (27 months vs 6 months, P = .0001).
Conclusions:
Doxycycline monotherapy resulted in a high rate of excellent clinical outcomes after a few treatments without increased need for subsequent operative resection. These results support use of doxycycline sclerotherapy as primary treatment for macrocystic and mixed LMs in children.
