OK432 Versus Doxycycline for Treatment of Macrocystic Lymphatic Malformations

Abstract

Objectives: A variety of sclerotherapy agents are used to treat macrocystic lymphatic malformations (LMs). This retrospective study at a single institution was performed to compare the outcomes of pediatric macrocystic LMs of the head and neck that were treated with doxycycline or with OK432. Methods:The outcomes measured included early response to therapy, number of treatments required, operating room time, and adverse events. Results:The rates of clinical success for OK432 and doxycycline were similar (83% and 82%, respectively; p > 0.05), although OK432-treated patients required more treatments than did doxycycline-treated patients (1.9 versus 1.0 injections; p = 0.01; 95% confidence interval, 1.57 to 0.27). The average operating room time for a single OK432 injection was significantly shorter than that for doxycycline (53.2 versus 98.1 minutes; p < 0.001); however, when the total number of treatments administered was considered, the overall times in the operating room were similar. Adverse events in the early postoperative period were more common in OK432-treated patients, who experienced marked postoperative swelling compared to doxycycline-treated patients.Conclusions: OK432 and doxycycline are both effective sclerosants for the treatment of predominantly macrocystic LMs. The administration time for OK432 is shorter than that for doxycycline, but OK432 required more treatments overall to achieve clinical success. Early adverse events were more common in OK432-treated patients, but longer follow-up is necessary to determine whether rates of recurrence and adverse events are similar, particularly in light of the risk of tooth discoloration in doxycycline-treated patients.

Sclerotherapy for lymphatic malformations of the head and neck in the pediatric population

“…The average pre-treatment volume varied between the different sclerosants but was not statistically significant (p=0.6618). Volumetric improvement was similar between the three sclerosing agents, with an average reduction of 84.5%, consistent with published literature 8 9. Ethanolamine had an average reduction in volume of 85.7% and OK-432 and doxycycline had an average reduction of 84.6% and 83.7%, respectively.…”

“…The outcome is consistent with that in the literature from many different sclerosants including OK-432, doxycycline, ethanolamine oleate, bleomycin, dextrose, ethanol, sodium tetradecyl sulfate, and acetic acid. The efficacy rates with these agents range from 62% to 100% 8 9. Published reports have shown that sclerotherapy is nearly four times more successful than surgical excision for treating LMs, at the same time carrying lower associated morbidity 10 17 30.…”

Outcome and clinical efficacy of bleomycin and doxycycline percutaneous sclerotherapy for treatment of paediatric lymphatic malformations in a limited resource setting

“…2,7,8 OK-432 is very effective and used widely, but it is unavailable in authors setting. 9 Doxycycline and bleomycin are readily available and cheap alternative. In this context, author planned this study to test the outcome and efficacy of using injection bleomycin and injection doxycycline in treating lymphatic malformation in a different group of patients.…”

The Role of Interventional Radiologists in the Treatment of Congenital Lymphatic Malformations

“…30,38 Since institutional review board approval is needed to use OK-432, and its efficacy is not superior to other sclerosants; its use in the United States is limited. 56…”