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Results of Injection Sclerotherapy with Bleomycin in Pediatric Lymphatic Malformations
Vipan Kumar1, Subhasis Roy Choudhury1, Partap Singh Yadav1
1Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Childrens Hospital, New Delhi, India.
Insights
Bleomycin sclerotherapy is a safe and effective first-line treatment for pediatric macrocystic lymphatic malformations, showing high rates of complete or significant regression in clinical studies.
Area of Science:
- Pediatric Surgery
- Vascular Anomalies
- Interventional Radiology
Background:
- Lymphatic malformations are congenital vascular anomalies that can cause significant morbidity in children.
- Macrocystic lymphatic malformations often require intervention to manage symptoms and improve quality of life.
Purpose of the Study:
- To evaluate the efficacy and safety of bleomycin injection sclerotherapy for pediatric macrocystic lymphatic malformations.
- To assess treatment outcomes including regression rates and complications.
Main Methods:
- Prospective cohort study of pediatric patients with macrocystic lymphatic malformations.
- Ultrasound-guided bleomycin sclerotherapy administered at 0.5 mg/kg (max 5 mg) with a 5:1 fluid-to-solution ratio.
- Clinical and ultrasound reassessment at three-week intervals to determine response.
Main Results:
- Sixty pediatric patients (mean age 3.22 years) with lymphatic malformations were treated.
- Excellent response (complete regression) achieved in 71.6% of patients; good response (>50% regression) in 20%.
- Common complications included fever (6 patients) and local pain (5 patients).
Conclusions:
- Bleomycin sclerotherapy is a simple, safe, and effective first-line treatment for pediatric macrocystic lymphatic malformations.
- The procedure demonstrates high efficacy with acceptable complication rates.
- Further research may explore long-term outcomes and optimal treatment protocols.
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.
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