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Pediatric Surgery International

, Volume 19, Issue 12, pp 766–773 | Cite as

Intralesional bleomycin injection (IBI) treatment for haemangiomas and congenital vascular malformations

  • T. MuirEmail author
  • M. Kirsten
  • P. Fourie
  • N. Dippenaar
  • G. O. Ionescu
Original Article

Abstract

Successful treatment of vascular anomalies has eluded the physician until now, despite various treatments utilised. Bleomycin has been successfully used in intralesional injection treatment of cystic hygromas and haemangiomas, based specifically on a high sclerosing effect on vascular endothelium. In a prospective study of 95 patients, the effectiveness of intralesional bleomycin injection (IBI) treatment in haemangiomas and vascular malformations was evaluated and documented. Complete resolution or significant improvement occurred in 80% of all patients treated. Complete resolution occurred in 49% of haemangiomas, 32% of venous malformations, and 80% of cystic hygromas. Significant improvement occurred in 38% of haemangiomas, 52% of venous malformations, 13% of cystic hygromas and 50% of lymphatic malformations. Of the six patients who presented with a painful lesion, four experienced complete resolution and two had significant improvement to treatment. Local complications encountered were superficial ulceration occurring in 2 patients, and cellulitis in 1 of the 95 patients. Systemic complications were flu-like symptoms in three patients and partial, transient hair loss in two patients. None of the patients presented with haematological toxic effects or signs of pulmonary involvement (fibrosis, hypertension). IBI is an effective treatment in haemangiomas and vascular malformation lesions, obviating the need for invasive primary surgery or systemic treatment regimens in 80% of cases, and allowing for limited need of secondary surgical or adjunctive procedures in cases with a moderate result.

Keywords

Bleomycin Haemangioma Vascular malformation Cystic hygroma 

References

  1. 1.
    Umezawa H (1966) Purification of bleomycins. J Antibiot 19:21–215Google Scholar
  2. 2.
    Blum R (1973) A clinical review of Bleomycin—a new antineoplastic agent. Cancer 31:903–914PubMedGoogle Scholar
  3. 3.
    Lopez-larraza D (1990) The kinetics of DNA damage by bleomycin in mammalian cells. Mutation Research 232:57–61PubMedGoogle Scholar
  4. 4.
    Yura J (1977) Bleomycin treatment for cystic hygroma in children. Arch Jap Chir 5 (46): 607–614Google Scholar
  5. 5.
    Tanigawa N (1987) Treatment of cystic hygroma and lymphangioma with the use of Bleomycin fat emulsion. Cancer 15:741–749Google Scholar
  6. 6.
    Tanaka K (1990) Sclerosing therapy with Bleomycin emulsion for lymphangioma in children. Ped Surg Int 5:270–273Google Scholar
  7. 7.
    Okada A (1992) Injection of Bleomycin as a primary therapy of cystic lymphangioma. J Ped Surg 27 (4): 440–443Google Scholar
  8. 8.
    Orford J (1995) Bleomycin therapy for cystic hygroma. J Ped Surg 30 (9):1282–1287Google Scholar
  9. 9.
    Sarihan H (1997) A new treatment with Bleomycin for complicated cutaneous hemangioma in children. Eur J Ped Surg 7:158–162Google Scholar
  10. 10.
    Kullendorf C (1997) Efficacy of Bleomycin treatment for symptomatic hemangiomas in children. Ped Surg Int 12:526–528CrossRefGoogle Scholar
  11. 11.
    Qin ZP (1998) Long term results of intratumorous Bleomycin-A5 injection for head and neck lymphangioma. Mosby Year Book 86 (2): 139–144Google Scholar
  12. 12.
    Enjolras O (1981) Classification and management of the various superficial vascular anomalies: hemangiomas and vascular malformations. J Dermatol 24:701–710Google Scholar
  13. 13.
    Mulliken JB (2000) Current problems in surgery. 37(8):517–584Google Scholar
  14. 14.
    Huston III J (1992) Magnetic resonance imaging of facial vascular anomalies. Mayo Clin Proc 67:739–747PubMedGoogle Scholar
  15. 15.
    Metry DW, Hebert AA, (2000) Benign cutaneous vascular tumours of infancy. Arch Dermatol.136:905–914Google Scholar
  16. 16.
    Sloan GM et al (1989) Intralesional corticosteroid therapy for infantile hemangiomas. Plast Reconstr Surg 83:459–467PubMedGoogle Scholar
  17. 17.
    Boon LM (1999) Complications of systemic corticosteroid therapy for problematic hemangioma. Plast Reconstr Surg. 104:1616–1623Google Scholar
  18. 18.
    Rogers M (2000) Treatment of ‘angiomas’:a modern commentary. Austral J Dermatol 41 [Suppl]:S89–S91Google Scholar
  19. 19.
    Weiss AH (1989) Adrenal suppression after corticosteroid injection of periocular hemangiomas. Am J Ophthalmol 107:518–522PubMedGoogle Scholar
  20. 20.
    Shorr N (1986) Central retinal artery occlusion associated with periocular corticosteroid injection for juvenile hemangioma. Ophthalmic Surg 14:229–231Google Scholar
  21. 21.
    Greinwald JH et al (1999) An update on the treatment of hemangiomas in children with interferon alpha-2a. Arch Otolaryngol Head Neck Surg 125:21–27PubMedGoogle Scholar
  22. 22.
    Scheepers JH et al (1995) Does the pulsed tunable laser have a role in the management of infantile hemangiomas? Observations based on 3 years’ experience.Plast Reconstr Surg 95:305–312PubMedGoogle Scholar
  23. 23.
    Drolet BA et al (1999) Hemangiomas in children. N Engl J Med 341:173–181CrossRefPubMedGoogle Scholar
  24. 24.
    Berenguer B et al (1999) Sclerotherapy of craniofacial venous malformations:complications and results. Plast Reconstr Surg 104:1–11PubMedGoogle Scholar
  25. 25.
    Mason KP et al (2000) Serum ethanol levels in children and adults after ethanol embolisation or sclerotherapy for vascular anomalies. Radiology 217:127–132PubMedGoogle Scholar
  26. 26.
    Luce JK (1969) Clinical trial of bleomycin in solid tumors and lymphomas. Proc Am Assoc Cancer Res10:38Google Scholar
  27. 27.
    Muggia FM (1983) Pulmonary toxicity of antitumour agents. Cancer Tr Rev 10:221–243Google Scholar
  28. 28.
    Ugur Ö et al (1993) Bleomycin lung toxicity detected by technetium-99m diethylene triamine penta-acetic acid aerosol scintigraphy. Eur J Nucl Med 20:114–118PubMedGoogle Scholar
  29. 29.
    Gangopadhyay AN et al (1997) Role of steroid in childhood haemangioma: a 10 years review. Int Surg 82:49–51PubMedGoogle Scholar
  30. 30.
    Enjolras O et al (1990) Management of alarming hemangiomas in infancy: a review of 25 cases. Pediatrics 85:491–498PubMedGoogle Scholar
  31. 31.
    Gelbert F et al (2000) Percutaneous sclerotherapy for venous malformation of the lips: a retrospective study of 23 patients. Interv Neurorad 42:692–696CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • T. Muir
    • 1
    • 2
    • 3
    Email author
  • M. Kirsten
    • 4
  • P. Fourie
    • 5
  • N. Dippenaar
    • 6
  • G. O. Ionescu
    • 4
  1. 1.MiddlesbroughUK
  2. 2.James Cook University HospitalMiddlesbroughUK
  3. 3.Department of Plastic and Reconstructive SurgeryUniversity of PretoriaPretoriaRepublic of South Africa
  4. 4.Department of Paediatric SurgeryUniversity of PretoriaPretoriaRepublic of South Africa
  5. 5.Interventional Radiology UnitUnitas HospitalPretoriaRepublic of South Africa
  6. 6.Department of PhysiologyUniversity of PretoriaPretoriaRepublic of South Africa

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