New approaches for solving the old problem

Abstract

Infantile hemangioma (IH) is a benign vascular tumor with abnormal proliferation of endothelial cells and impaired vascular architecture. It is believed that the pathogenesis of IH is based on angiogenesis impairment caused by imbalance between angiogenic and anti-angiogenic factors. Despite spontaneous regression, which is observed in 90% of cases of IH, several tumor localizations may indicate the possibility of systemic manifestations or lead to the development of complications that require medical interventions. Here we report 2 cases of the most frequent and severe complications of IH and the first successful use of combined treatment strategy including metronomic chemotherapy (cyclophosphamide plus vinblastine) and nonselective b-blocker (propranolol) in IH. The parents of the patients agreed to use the information, including the photographs of children, in scientific research and publications. In contrast to glucocorticoids commonly used in clinical practice for complicated forms of IH, metronomic chemotherapy showed high efficacy and safety. It led to a rapid, within the first two weeks, clinical improvement resulting not only in stopping tumor growth, but even in size reduction. Such a rapid response to therapy allowed to stop the development of ulcers and necrosis with secondary infection, and to prevent severe vital complications of IH such as the upper respiratory tract compression.