Surveillance Chest X-Ray and Pulmonary Function Testing in Patients Undergoing Intralesional Bleomycin in the Treatment of Vascular Malformations

Abstract

Purpose: Bleomycin is an effective sclerosant in the treatment of vascular malformations; however, the risk of pulmonary toxicity remains a concern. This study analyzes the utility of routine chest x-ray (CXR) and pulmonary function testing (PFT) in a pediatric patient population receiving intralesional bleomycin sclerotherapy. Methods: Retrospective chart review of CXR and PFT results in patients who underwent bleomycin intralesional injection for the treatment of vascular malformations. Results: A total of 64 patients were identified with vascular malformations treated with intralesional bleomycin. The median cumulative bleomycin dose per patient was 10.9 U/m2 (range 1.8–106.8 U/m2 per patient). No difference was found in mean cumulative bleomycin dose between patients with a normal compared with abnormal CXR (32.4 versus 31.8 U/m2, P = 0.96). No patients had CXR findings which precluded the administration of bleomycin. Of 41 successfully completed PFTs, 39 (95.1%) were normal and 2 (4.9%) were abnormal with an obstructive pattern. There was no decrease in the mean DLCO (Hg) % predicted between baseline PFT and follow-up PFT groups (94.1 versus 101.8, P = 0.17). Linear regression was performed and no decrease in DLCO (Hg) % predicted with increasing cumulative bleomycin dose was identified (slope coefficient 0.37; 95% CI, –2.2 to 2.9; R2 = 0.01). Conclusion: Routine CXR for the surveillance of bleomycin-induced pulmonary toxicity seems to be of limited clinical utility. No diffusion abnormalities on PFT were seen in this patient cohort to date; however, as cumulative bleomycin doses increase, follow-up PFT monitoring will remain important.