Modern treatment of infantile hemangioma

Infantile hemangioma (IH) is the most common benign vascular tumor in children of the first year, which is based on abnormal proliferation of endothelial cells under the influence of the main pro-angiogenic factors: vascular endothelial growth factor (VEGF) and fibroblast growth factors (FGF). It develops in the first weeks after birth, forming over 3–9 months with regression in the next 3–7 years. Three-quarters of infantile hemangiomas are nodular and are not accompanied by malformations. At the same time, segmental IH is most often associated with syndromic forms. Despite spontaneous regression (in 90% of cases), some forms and localization of IH can lead to the development of complications, local and endangering vital functions. In most cases, the diagnosis is based on anamnesis, characteristic features of the tumor, and clinical course. Additional studies (ultrasound DG, MRI/CT, biopsy) are necessary in complicated forms and in doubtful clinical cases.

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Infantile hemangioma explained in simple terms

Pediatric Hematology/Oncology and Immunopathology ◽

10.24287/1726-1708-2021-20-1-192-206 ◽

2021 ◽

Vol 20 (1) ◽

pp. 192-206

Author(s):

L. A. Khachatryan ◽

I. S. Kletskaya

Keyword(s):

Endothelial Cells ◽

Spontaneous Regression ◽

Clinical Course ◽

Scientific Research ◽

Infantile Hemangioma ◽

Vascular Tumor ◽

Angiogenic Factors ◽

First Year ◽

Vital Functions ◽

Characteristic Features

Infantile hemangioma (IH) it is the most common benign vascular tumor in children of the first year, which is based on abnormal proliferation of endothelial cells under the influence of the main pro-angiogenic factors VEGF and FGF. It develops in the first weeks after birth, forming over 3–9 months with regression in the next 3–7 years. Three-quarters of infantile hemangiomas are nodular and are not accompanied by malformations. At the same time, segmental IH is most often associated with syndromic forms. Despite spontaneous regression (in 90% of cases), some forms and localization of IH can lead to the development of complications, local and endangering vital functions. In most cases, the diagnosis is based on anamnesis, characteristic features of the tumor, and clinical course. Additional studies (ultrasound DG, MRI/CT) are necessary in complicated forms and in doubtful clinical cases. The patient's parents agreed to use the information, including the child's photo, in scientific research and publications.

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P14.08 Bevacizumab treatment for the lesion emerging after the radiotherapy for malignant glioma

Neuro-Oncology ◽

10.1093/neuonc/noz126.244 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii68-iii68

Author(s):

K Miwa ◽

T Ito ◽

K Yokoyama ◽

J Shinoda

Keyword(s):

Malignant Glioma ◽

Tumor Recurrence ◽

Clinical Course ◽

Radiation Necrosis ◽

Neurological Dysfunction ◽

Vascular Endothelial ◽

Recurrent Malignant Glioma ◽

Positron Emission ◽

Bevacizumab Treatment ◽

Endothelial Growth Factor

Abstract BACKGROUND Because blocking vascular endothelial growth factor from reaching leaky capillaries is a logical strategy for the treatment, we reasoned that bevacizumab might be an eﬀective treatment on recurrent malignant glioma and radiation necrosis (RN). In this study, the authors examined to diﬀerentiate RN from recurrent malignant glioma, and evaluated the results of bevacizumab treatment in each diagnosis. MATERIAL AND METHODS Four patients of malignant glioma (2 glioblastomas and 2 anaplastic astrocytomas), which demonstrated symptomatic lesion after radiotherapy, were involved in this study. All four patients were treated with bevacizumab on a 10 mg/kg biweekly (one cycle), for a total dose of 30 mg/kg (3 cycles) or furthermore. RN was diﬀerentiated from local recurrence in all four patients on the basis of 11C-methionine positron emission tomography and/or clinical course. Clinical evaluation and MRI studies were obtained after bevacizumab treatment in all cases repeatedly as possible. RESULTS Two patients were diagnosed as RN, and another two patients as tumor recurrence. Of the two patients with RN, neurological dysfunction was distinctly alleviated after bevacizumab treatment. Other two patients with tumor recurrence demonstrated no remarkable improvement in neurological dysfunction after bevacizumab treatment. Of all the two patients with RN, post-treatment MRI performed after the bevacizumab therapy showed a significant reduction of the massive lesion. CONCLUSION We concluded that bevacizumab could control the symptomatic massive lesion occurring after radiotherapy, and it might be more eﬀective with the patients of RN, than with those of recurrent tumor.

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Use of thalidomide to diminish growth velocity in a life-threatening congenital intracranial hemangioma

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/2/8/125 ◽

2008 ◽

Vol 2 (2) ◽

pp. 125-129 ◽

Cited By ~ 13

Author(s):

Melissa Frei-Jones ◽

Robert C. McKinstry ◽

Arie Perry ◽

Jeffrey R. Leonard ◽

Tae Sung Park ◽

...

Keyword(s):

Growth Factor ◽

Growth Velocity ◽

Vascular Tumor ◽

Capillary Hemangioma ◽

Interferon Α ◽

Vascular Endothelial ◽

Infectious Risk ◽

Intracranial Lesions ◽

Life Threatening ◽

Endothelial Growth Factor

Infantile or capillary hemangioma is the most common vascular tumor of childhood. The tumors most frequently affect the head and neck area, but rare cases of intracranial lesions have been reported. Their natural history is marked by initial rapid growth velocity followed by a plateau and, in most cases, subsequent involution. Although the lesions are considered benign, 10% of affected children develop life-threatening complications (mortality rate 20–80% in this subgroup). When surgical intervention or other methods of local control are not possible, therapeutic options are limited. Corticosteroids have been the mainstay of therapy but therapeutic response is not predictable and the infectious risk is not negligible. Interferon α-2a may also be effective but has significant toxicities. Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) have been implicated in the pathogenesis of hemangiomas, and antiangiogenesis agents are being evaluated in the treatment of these tumors. Thalidomide may be an ideal therapy for life-threatening hemangiomas because it inhibits new blood vessel formation by antagonizing both the bFGF and VEGF pathways and has a more acceptable toxicity profile than other agents. The authors present the case of an infant born with a life-threatening, unresectable intracranial hemangioma in which treatment with thalidomide resulted in a good clinical outcome.

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