Radiotherapy of childhood haemangiomas: From active treatment to radiation risk estimates

Abstract

Childhood skin haemangiomas have been subjected to many different kinds of active treatment. From the beginning of the twentieth century and up to 1960-1970, radiotherapy maintained a dominating place in this treatment, although during the latter part of this period its role was more and more questioned. Starting in 1958, I felt that, based on the scientific literature and on my own observations at Malmö University Hospital, active therapy including radiotherapy should be abandoned since it had turned out to be unnecessary and, furthermore, could be harmful. This viewpoint resulted from an increased knowledge of the natural history of the disease. I then got the possibility to establish a follow-up study cohort at Sahlgrenska University Hospital in Göteborg with the aim of gaining information on early and late radiation effects following childhood radiotherapy. Later, the study cohort was enlarged by pooling with similar cohorts originating from Stockholm and Paris. A summary of the results of the epidemiological studies is also presented here. This historical overview reflects half a century of radiation therapy and radiation protection philosophy. It contains a basic message pointing to the value of proper and reliable collection of medical data and to the importance of local, regional and national registers, to preserve the information.

A huge infiltrating squamous cell carcinoma of the neck 46 years after radiotherapy of a haemangioma

“…Therefore the exposure to ultraviolet radiation is the most common cause of this type of cancer, but several other factors even promote the development of a SCC on the skin. 2,3,8,9 Ionizing radiation has also been implicated in the pathogenesis of squamous-cell carcinoma. In the 1940s and 1960s ionizing radiation was used to treat many cutaneous conditions, including acne, dermatitis and haemangioma.…”

“…In the 1940s and 1960s ionizing radiation was used to treat many cutaneous conditions, including acne, dermatitis and haemangioma. 8,9 The most patients treated with radiotherapy for such a benign tumour were children with a haemangioma in the head and neck. While these treatments generally were effective they resulted in enhanced cancer risks and the use of radiotherapy for benign disease has declined.…”

“…In the first half of the 20th century the radiotherapy of haemangioma and other benign tumours of the skin was a common method. 4,8,9 The importance of the irradiation of haemangioma in early childhood diminished because of the high spontaneous regression of the haemangioma, located in head and neck area.…”

Squamous cell carcinoma as a long-term effect after skin vascular malformation radiotherapy

“…In the past, Agervall and Kindblom described vascular anomaly as a benign vascular tumor: "broadly defined as a lesion with an increased number of newly formed blood vessels... It is present at birth or it could appear soon after" [2,3]. The most frequent type of vascular malformations is the stork bite (erythema nuchae) which presents in 40-50% of all newborns.…”

“…Radiotherapy was one of the most common ways to treat vascular anomalies in Europe until the 1960s. In those days this approach to the vascular anomalies seemed to be harmless and generally accepted as a non-invasive treatment causing no scaring [2,6,7]. It was advocated to initiate the therapy as early as possible to stop the evolution of this lesion because it was believed that vascular anomalies in younger children is much sensitive to radiotherapy.…”