Advances in Hemangioma Evaluation and Treatment

Infantile hemangioma status by dynamic infrared thermography: A preliminary study

BACKGROUND

Infantile hemangiomas (IH) are initially warm due to increased proliferation and perfusion then involute with apoptosis and reduced perfusion. Objective quantitative evaluation of IH treatment response is essential for improving outcomes. We applied a functional imaging method, dynamic infrared (IR) thermography, to investigate IH status versus control skin and over time.

MATERIALS AND METHODS

A preliminary prospective observational study was conducted among 25 subjects with superficial or mixed IHs (< 19 months) over 59 clinic visits. Infrared images of IHs and control sites, standardized color images, and three-dimensional images were obtained. Tissue responses following application and removal of a cold stress were recorded with video IR thermography. Outcomes included areas under the curve during cooling (AUCcool ) and rewarming (AUCrw ) and thermal intensity distribution maps.

RESULTS

AUCcool and AUCrw were significantly higher and cooling rate slower for IHs versus uninvolved tissue indicating greater heat, presumably due to greater perfusion and metabolism for the IH. IR distribution maps showed specific areas of high and low temperature. Significant changes in IH thermal activity were reflected in the difference (AUCcool - AUCrw ), with 6.2 at 2.2 months increasing to 37.6 at 12.8 months. IH cooling rate increased with age, indicating slower recovery, and interpreted as reduced proliferation and/or involution.

CONCLUSIONS

Dynamic IR thermography was a well-tolerated, quantitative functional imaging modality appropriate for the clinic, particularly when structural changes, i.e., height, volume, color, were not readily observed. It may assist in monitoring progress, individualizing treatment, and evaluating therapies.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov (Identifier NCT02061735).

Interferon-alpha for alarming hemangiomas in infants: experience of a single institution

BACKGROUND

Hemangioma is the most common tumor in infancy. 'Alarming hemangiomas' refer to the lesions that potentially impair vital structures or cause life-endangering complications, and which warrant vigorous treatment. Interferon-alpha has been used for alarming hemangiomas at Mackay Memorial Hospital, Taipei, Taiwan, since 1994.

METHODS

The records of 21 consecutive infants treated between January 1994 and December 2005 were retrospectively reviewed. The initial dose of interferon-alpha was 50 000 IU/kg per day, which was increased to 100,000 IU/kg per day in the second week of therapy if tolerated. It was tapered depending on response, with total treatment lasting no longer than 12 months. Treatment response was evaluated depending on the size of the lesion and resolution of complications.

RESULTS

The duration of therapy ranged from 6 to 12 months. Six patients (29%) had a reduction in mass of > or =25% after 1 month of therapy. Twenty patients (95%) had achieved a decrease in size of 50% by 12 months, and 15 (71%) had total involution of lesions by a median age of 13.5 months (range 7-50 months). Only mild and transient adverse effects were encountered. No neurologic complications occurred.

CONCLUSIONS

Interferon-alpha appears to be an effective and well-tolerated treatment for alarming hemangiomas in infancy.