Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
The Relationship of Propranolol Treatment Success with the Location of Hemangioma and Patient Age: A Retrospective Study
Propranolol Tedavisi Başarısında Hemanjiyomun Yeri ve Hasta Yaşı ile İlişkisi: Retrospektif Çalışma
Olga Devrim AYVAZa, Cengiz GÜLa, Merve Tuğçe ORBAYa, Sırma Mine TİLEVa, Ayşenur CELAYİRa
aDepartment of Pediatric Surgery, University of Health Sciences İstanbul Zeynep Kamil Maternity and Children's Diseases Health Training and Research Center, İstanbul, TURKEY
Turkiye Klinikleri J Med Sci. 2021;41(3):197-204
doi: 10.5336/medsci.2021-81526
Article Language: EN
Full Text
ABSTRACT
 Objectiveː Propranolol causes shrinkage of hemangiomas through capillary vasoconstriction, increased endothelial cell apoptosis, and decreased vascular endothelial growth factors. This study aimed to evaluate the relationship between propranolol treatment success, the location of hemangioma and patient age. Material and Methodsː Children with hemangiomas treated with propranolol between October 2016 and April 2019 were evaluated retrospectively. Propranolol was administered as 0.5 mg/kg/day. Vital signs, blood pressure and blood glucose were monitored while the dose was gradually increased to 2 mg/kg/day. Paling and shrinking of the lesions in monthly follow-ups were considered as success of the treatment. Resultsː The median treatment age in 31-children (61.3% females, 38.9% males) with hemangiomas was 6-month (1 months-16 years), the mean treatment duration was 7.74±3.66months (3 months-18 months). Hemangiomas located in head/neck-17 cases(54.8%), in trunk- 4 cases (12.9%), in genital/gluteal -4 cases(12.9%), in abdomen-4 cases (12.9%) and on extremities-3 cases (7%). Four (12.9%) patients had multiple hemangiomas. Three (9.7%) had hepatic hemangioma diagnosed prenatally. 51.6% of were between 1-3 cm2 . Blood glucose levels were stable in all. Propranolol therapy was ineffective in 4-patient aged 7, 8, 29, and 90-month, 3 with head and neck hemangiomas and 1 with trunk hemangioma. In 27-patient who had treatment success, propranolol was discontinued when the reduction in lesion size stabilized. Conclusionː Propranolol is preferred because of its ease of use, low side effects, cost-effectiveness, and rapid response. It can be successfully used even in liver hemangiomas by close monitoring of vital signs, blood sugar, and blood pressure. Treatment success of propranolol is independent of age and hemangioma location.

Keywords: Child; hemangioma; propranolol
ÖZET
 Amaç: Propranolol, kapiller vazokonstriksiyon yoluyla hemanjiyomların küçülmesine, artmış endotel hücre apoptozuna ve vasküler endotelyal büyüme faktörlerinin azalmasına neden olur. Bu çalışmada, propranolol tedavi başarısı ile hemanjiyomun yeri ve hasta yaşı arasındaki ilişkinin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Ekim 2016 ile Nisan 2019 tarihleri arasında propranolol ile tedavi edilen hemanjiyomlu çocuklar retrospektif olarak değerlendirildi. Üç günlük hospitalizasyonda vital bulgu, kan basıncı ve kan şekeri izlenirken, Propranolol 0,5mg/kg/gün'dan kademeli olarak 2 mg/kg/gün'e artırıldı. Aylık takiplerde lezyonların renginin solması ve küçülmesi tedavi başarısı olarak kabul edildi. Bulgularː 19'u (%61,3) kız, 12'si (%38,9) erkek olmak üzere hemanjiyomlu 31 çocukta medyan tedaviye başlama yaşı 6 ay (1 ay-16 yaş) idi. Ortalama propranolol tedavi süresi 7,74±3,66 ay (3ay-18ay)'dı. Hemanjiyomlar 17'sinde (%54,8) baş-boyun, 4'ünde (%12,9) gövde, 4'ünde (%12,9) genital/gluteal, 4'ünde (%12,9) abdomen, 3'ünde ekstremitelerde (%7) yerleşimliydi. Dört olguda (%12,9) birden fazla lokalizasyonda hemanjiyom mevcuttu. Prenatal tanılı üç olgu (%9,7) karaciğer hemanjiyomluydu. Hemanjiyomların çoğunluğu (%51,6) 1-3 cm2 boyutundaydı. Tüm hastalarda kan glukoz seviyeleri stabildi. Yedi, 8, 29 ve 90 aylık 4 hastada propranolol tedavisi etkisiz kaldı, bunların 3'ünde baş ve boyun hemanjiyomu, 1'inde gövde hemanjiyomu vardı. Tedavinin başarılı olduğu 27 hastada propranolol tedavisi lezyon boyutundaki azalma stabilize olduğunda kesildi. Sonuç: Propranolol kullanım kolaylığı, düşük yan etkileri, uygun maliyeti ve hızlı yanıt vermesi nedeniyle tercih sebebidir. Propranolol, vital bulgu, kan şekeri ve kan basıncının yakından izlenmesiyle karaciğer hemanjiyomlarında bile başarıyla uygulanabilir. Propranololün tedavi başarısı yaş ve hemanjiyomun yerleşim yerinden bağımsızdır.

Anahtar Kelimeler: Çocuk; hemanjiyom; propranolol
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