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Treatment of isolated lymphatic malformation with the herbal medicine "Eppikajyutsuto": a retrospective multicenter
Naoki Hashizume1,2, Takafumi Kawano3, Koshiro Sugita4,3
1Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan. hashidume_naoki@kurume-u.ac.jp.
Purpose:
The present study analyzed the clinical efficacy of the herbal medicine "Eppikajyutsuto" (TJ-28) for isolated lymphatic malformation (LM).
Methods:
LM patients treated with TJ-28 monotherapy were retrospectively reviewed using medical records at three pediatric surgery departments from 2009 to 2023. All patients underwent ultrasound or/and magnetic resonance imaging before and after treatment. The isolated LM lesions were classified as macrocystic, microcystic, and mixed cystic according to the International Society for the Study of Vascular Anomalies classification. The LM volume index (LVI) was defined as the longitudinal length (mm) x width (mm) x depth (mm). The degree of reduction ratio (LVI ratio) was defined as the post-administration LVI divided by the pre-administration LVI.
Results:
Thirty-three cases (15 males, 18 females) of LM treated with TJ-28 were enrolled. Data are presented as median (range). The median age started treatment was 20 (0, 112) months. The median treatment duration was 12 (1-81) months. Of 28 patients, LVI ratio was calculated. Eighteen cases had macrocystic LM, 2 cases had microcystic LM and 8 cases had mixed macro-microcystic LM. There were significant differences between the pre-administration and post-administration LVI 32118 [1425, 1125000] mm3 vs 5087 [0, 50000] mm3, p < 0.001). Classified ISSVA: there were significant differences between the pre-administration and post-administration LVI of macrocystic (n = 18) (33,646 [3080, 1125000] mm3 vs 4937.5 [0, 50000] mm3, p < 0.001) and mixed macro-microcystic LM cases (n = 8) (37,952 [1425, 124488] mm3 vs 5134 [24, 41040] mm3, p = 0.0078). For microcystic LM cases (n = 2), there were no significant differences between the pre-administration and post-administration LVI (17,420 [5600, 29240] mm3 vs 30,180.5 [4550, 55811] mm3, p = 0.500). The median LVI ratio was 0.20 (0-1.91). The median LVI ratio of macrocystic LM was 0.21 (0-1.05) and the median LAI ratio of mixed macro-microcystic LM was 0.19 (0-1.01). Microcystic LM cases did not improve.
Conclusions:
This study demonstrates the beneficial effects of TJ-28 for macrocystic LM and mixed macro-microcystic LM.
Level Of Evidence:
A prognosis study of level IV.
