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Single Center Experience of Sirolimus Therapy in Head and Neck Low-flow Vascular Malformations.
- Source :
-
Vascular and endovascular surgery [Vasc Endovascular Surg] 2021 Jul; Vol. 55 (5), pp. 482-490. Date of Electronic Publication: 2021 Apr 21. - Publication Year :
- 2021
-
Abstract
- Objective: Recently, studies have shown that sirolimus is clinically efficacious in the treatment of some low-flow vascular malformations (LFVM). This study aimed to assess the efficacy and safety of sirolimus in treating complex head and neck (H&N) LFVM that were challenging and/or refractory to standard treatment.<br />Methods: Each patient had baseline and 6-months assessments consisting of clinical history and examination, quality of life (QoL) questionnaires, laboratory investigations, MRI and medical photography. Patients were followed up 1-week and then 1-monthly for 6-months. Wilcoxon signed-rank test was used to compare pre-and 6-months treatment in all 8 domains of RAND 36-Item Short Form Health Survey (SF-36), hospital anxiety and depression scale (HADS), and visual analog score for pain (VAS-P). P < 0.05 was considered significant.<br />Results: Seven patients (median age 43 years, range 23-65 years) were recruited. Six patients completed the six-months course of therapy with 1 patient withdrawing due to intolerable side effects. All six patients reported reduction of swelling with and without other symptom improvement related to the vascular malformations while on treatment. However, at 1-month review after discontinuation of sirolimus, 5 patients reported return of initial symptoms. Overall, patients demonstrated an improvement in QoL six-months treatment but there was no statistical significance (P > 0.05) in all 8 domains of SF-36, HADS and VAS-P. Five patients demonstrated a minimum 10% decrease in lesion size six-months treatment (median 21%, range 13-40%). A Wilcoxon signed-rank test showed that sirolimus treatment did elicit a statistically significant change in lesion size in either direction (Z = -1.992, P = 0.046). The most common side effects found were dyslipidaemia (n-4) and mouth ulcers (n = 2).<br />Conclusion: In our preliminary experience, sirolimus is effective and safe in treating patients with complex H&N LFVM. This provides an alternative treatment where standard treatment is challenging and/or refractory.
- Subjects :
- Adult
Aged
Blood Flow Velocity
Female
Humans
Male
Middle Aged
Quality of Life
Regional Blood Flow
Sirolimus adverse effects
Time Factors
Treatment Outcome
Vascular Malformations diagnostic imaging
Vascular Malformations physiopathology
Young Adult
Sirolimus therapeutic use
Vascular Malformations drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1938-9116
- Volume :
- 55
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Vascular and endovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 33878964
- Full Text :
- https://doi.org/10.1177/15385744211010378