Treatment of children and adolescents with hemangioma using propranolol
preliminary results from a retrospective study
Keywords:
Hemangioma, capillary, Propranolol, Retrospective studies, Treatment outcome, Medical oncologyAbstract
CONTEXT AND OBJECTIVE: Hemangiomas are the commonest vascular tumors during childhood. In 2008, the effect of propranolol for treating capillary hemangiomas was demonstrated. Other similar results followed,showing that it rapidly reduces lesion volume. The objective here was to evaluate children and adolescents with hemangiomas that were treated with propranolol. DESIGN AND SETTING: Retrospective study, conducted in a children’s hospital. METHODS: Patients aged 0-19 years with or without previous treatment, who were treated between January 2009 and December 2010, were included. The response was assessed by comparing the lesion appearance between the start of treatment and the last consultation. We considered partial or complete responses as the response to treatment. RESULTS: Sixty-nine patients with a median follow-up of 11 months (mean age: 31 months) were included. Of these, 58 patients were recently diagnosed and 11 had had previous treatment. A response (partial or complete) was seen in 60 patients (87%). Among the capillary hemangioma cases, responses were seen in 50 out of 53 (94%), while in other lesion types, it was 10 out of 16 (63%) (P = 0.3; chi-square). Responses in patients less than one year of age were seen in 37 out of 38 (97%), whereas in those over one year of age, in 23 out of 31 (74%) (P = 0.4; chi-square). Side effects were uncommon and mild. CONCLUSIONS: Propranolol seemed to be effective for treatment of hemangiomas in children and adolescents, and not just in the proliferative stage, with responses in almost all the patient.
Downloads
References
Felix FHC. Tratamento dos hemangiomas da infância [Treatment of hemangioma in pediatric patients. Revista de Saúde da Criança. 2011;3(2):39-45. Available from: http://www.hias.ce.gov.br/revista-da-crianca/category/10-volume-3-nmero-2-julho-a-dezembro-de-2011. Accessed in 2013 (Jun 11).
Hemangioma Investigator Group, Haggstrom AN, Drolet BA, et al. Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. J Pediatr. 2007;150(3):291-4.
Marler JJ, Mulliken JB. Current management of hemangiomas and vascular malformations. Clin Plast Surg. 2005;32(1):99-116, ix.
Adams DA, Wentzel MS. The role of the hematologist/oncologist in the care of patients with vascular anomalies. Pediatr Clin North Am. 2008;55(2):339-55, viii.
Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, et al. Propranolol for severe hemangiomas of infancy. N Engl J Med. 2008;358(24):2649-51.
North PE, Waner M, Mizeracki A, Mihm MC Jr. GLUT1: a newly discovered immunohistochemical marker for juvenile hemangiomas. Hum Pathol. 2000;31(1):11-22.
North PE, Waner M, James CA, et al. Congenital nonprogressive hemangioma: a distinct clinicopathologic entity unlike infantile hemangioma. Arch Dermatol. 2001;137(12):1607-20.
Léauté-Labrèze C, Taïeb A. Efficacité des bêtabloquants dans les hémangiomes capillaires infantiles: signification physiopathologique et conséquences thérapeutiques [Efficacy of beta-blockers in infantile capillary haemangiomas: the physiopathological significance and therapeutic consequences]. Ann Dermatol Venereol. 2008;135(12):860-2.
Iannetti G, Torroni A, Chiummariello S, Cavallotti C. Clinical and morphological characteristics of head-facial haemangiomas. Head Face Med. 2007;3:12.
Storch CH, Hoeger PH. Propranolol in infantile haemangiomas: insights into the molecular mechanisms of action. Br J Dermatol. 2010;163(2):269-74.
D’Angelo G, Lee H, Weiner RI. cAMP-dependent protein kinase inhibits the mitogenic action of vascular endothelial growth factor and fibroblast growth factor in capillary endothelial cells by blocking Raf activation. J Cell Biochem. 1997;67(3):353-66.
de Groot AA, Mathy MJ, van Zwieten PA, Peters SL. Involvement of the beta3 adrenoceptor in nebivollol-induced vasorelaxation in the rat aorta. J Cardiovasc Pharmacol. 2003;42(2):232-6.
Greenberger S, Adini I, Boscolo E, Mulliken JB, Bischoff J. Targeting NF-B in infantile hemangioma-derived stem cells reduces VEGF-A expression. Angiogenesis. 2010;13(4):327-35.
Itinteang T, Brasch HD, Tan ST, Day DJ. Expression of components of the renin-angiotensin system in proliferating infantile haemangioma may account for the propranolol-induced accelerated involution. J Plast Reconstr Aesthet Surg. 2011;64(6):759-65.
de Graaf M, Breur JM, Raphaël FM, et al. Adverse effects of propranolol when used in the treatment of hemangiomas: a case series of 28 infants. J Am Acad Dermatol. 2011;65(2):320-7.
Sans V, de la Roque ED, Berge J, et al. Propranolol for severe infantile hemangiomas: follow-up report. Pediatrics. 2009;124(3):e423-31.
Holmes WJ, Mishra A, Gorst C, Liew SH. Propranolol as first-line treatment for rapidly proliferating infantile haemangiomas. J Plast Reconstr Aesthet Surg. 2011;64(4):445-51.
Schiestl C, Neuhaus K, Zoller S, et al. Efficacy and safety of propranolol as first-line treatment for infantile hemangiomas. Eur J Pediatr. 2011;170(4):493-501.
Starkey E, Shahidullah H. Propranolol for infantile haemangiomas: a review. Arch Dis Child. 2011;96(9):890-3.
Hogeling F, Adams S, Wargon O. A randomized controlled trial of propranolol for infantile hemangiomas. Pediatrics. 2011;128(2):e259-66.