Treatment of lymphangioma with an intralesional injection of low-concentration pingyangmycin: a report of 1110 cases

Abstract

Objective To explore the safety and efficacy of treating lymphangioma with an intralesional injection of low-concentration pingyangmycin by ultrasonic guidance under sedation. Methods A total of 1110 cases with soft tissue lymphangioma aged from 1-212 months received an intralesional mini-invasive injection of low-concentration pingyangmycin by ultrasonic guidance. The clinical pathological types were large cystic lymphangioma (cystic hygroma, n=233), utricle lymphangioma (n=391), cavernous lymphangioma (n=247), mixed lymphangioma (n=224) and diffuse lymphangioma (n=15). Under basal anesthesia, the concentration of pingyangmycin for large cystic lymphangioma and utricle lymphangioma was 0.4 mg/ml via cyst cavity injection and 0.33 mg/ml for other types via multi-point injection into tumor. The maximal dose of single therapy: <4 mg for school-age children (≥5 years); <2-3 mg for children aged 3-5 years; <2 mg for kids (<3 years); <1 mg for infants (<1 year) and <0.5 mg for infants aged <6 months. Pingyangmycin was never used in children aged <1 month and applied cautiously in children aged 1-2 months. They received single injection every 2-3 months for 1-10 cycles. Results Among 1110 cases of soft tissue lymphangioma, the clinical responses were complete remission (51.62%), excellent partial remission (41.53%), partial remission (4.59%), micro-remission (1.17%) and stable disease (1.08%). Among them, the curative effect of large cystic lymphangioma was the best and 100% children achieved CR; the next was utricle lymphangioma and 86.96% children achieved CR. Only children with large cystic lymphangioma or utricle lymphangioma achieved CR. VGPR for cavernous lymphangioma was 83.40% and 91.07% for mixed lymphangioma. The curative effect of diffuse lymphangioma was the worst and 80% children achieved SD and 20% MR. The incidence rate of such delayed complications as bleeding within tumor and infection was 3.42%. There was no such severe complication as acute infection, skin burst, necrosis, cirrhosis or pulmonary fibrosis. Conclusions By ultrasonic guidance under sedation, intralesional precise and mini-invasive injection of low-concentration pingyangmycin is both safe and efficacious for lymphangioma. Key words: Lymphangioma; Pingyangmycin; Sedation