Clinical and Imaging Outcomes of Doxycycline Exchange Sclerotherapy for Lymphatic Malformations

To evaluate serial doxycycline exchanges (SDEs) to treat lymphatic malformations (LMs).

Retrospective chart review of patients undergoing LM sclerotherapy with SDEs at the authors' tertiary care academic institution from April 2003 through March 2023. The primary outcome measure was change in symptoms between pretreatment and posttreatment clinical notes. Secondary outcomes included percent change in lesion volume measured from imaging studies and 30-day adverse events.

Forty-six patients (25 males [54.3%]; mean age at presentation, 15 years ± 22) received a mean of 1.9 treatments (SD ± 1.0) with 4.8 exchanges (SD ± 2.3) per treatment, including initial instillation, in the interventional radiology suite. Swelling (28/46, 60.9%) and discomfort (8/46, 17.4%) were the most prevalent initial symptoms. Of 46 patients, 24 (52.2%) had 1 SDE admission, 14 (30.4%) had 2 separate admissions, and 8 (17.4%) had ≥3 separate admissions. Of 44 patients with appropriate follow-up to assess clinical change, 4 (9.1%) experienced full clinical remission, 27 (61.4%) experienced improved clinical symptoms, and 13 (29.5%) experienced either unchanged or increased symptoms. LM size was reduced by a median of 63.4% (interquartile range [IQR], 63.9%) after 1 series of exchanges and by 64.4% (IQR, 69.5%) after 2 series of exchanges relative to lesion size after the first series of exchanges.

Most patients had improved clinical symptoms and reduced LM size at the conclusion of SDE therapy. SDE therapy is a safe and effective LM treatment that allows multiple sclerotherapy sessions with 1 procedure, which has the potential to reduce radiation-, procedural-, and anesthesia-associated risks.