Comparison of intralesional bleomycin with/without doxycycline in the primary management of pediatric lymphangiomas

Abstract

Background: Although surgical excision is the treatment of choice for lymphangiomas, recently many centers are practicing intralesional sclerotherapy as the primary modality. The purpose of this study was to review the efficacy of intralesional Bleomycin, to study the efficacy of a combination of intralesional bleomycin and doxycycline and compare the results. Materials and Methods: In this clinical observational study, all patients were evaluated clinically and color Doppler ultrasonography. Patients were grouped into Group A, in which intralesional Bleomycin alone and Group B, in which a combination of intralesional Bleomycin and Doxycycline was instilled into the cysts. The clinical response was assessed and compared between the groups. Results: Out of 52 patients in the study, the most common site of lymphangioma was cervical 28 (53%) and the most common type was macrocystic lesion 44 (84.5%). In Group A, out of 26 patients, the response was excellent in 15 (58%), satisfactory in 8 (30%), and poor in 3 (12%). In Group B, out of 26 patients, the response was excellent in 22 (85%), satisfactory in 2 (7.5%), and poor in 2 (7.5%). The postprocedure complications were observed more in Group A than Group B, of which the most common was pain/tenderness in five patients followed by redness and fever. Conclusion: Intralesional bleomycin alone and a combination of intralesional bleomycin and Doxycycline injection both can be safe and effective sclerosant formulas for primary nonsurgical management. The use of combination of Bleomycin and Doxycycline required fewer treatment sessions to obtain clinical success compared to Bleomycin alone.