THE RESPONSE OF PAROTID HEMANGIOMAS TO THE USE OF SYSTEMIC INTERFERONALFA-2A OR CORTICOSTEROIDS

Objective: To evaluate medical treatment for hemangiomas involving the parotid area with or without other areas of involvement. Design: Retr ospective analysis of pediatric patients treated medically for prolife rative hemangiomas of the parotid region with or without hemangiomas i n other regions. Indication for treatment included respiratory symptom s relating to hemangiomas of the upper airway, difficulty feeding, rap id rate of growth of the hemangioma, and deformity or obstruction of t he ear canal. Setting: New York University Multidisciplinary Vascular Anomaly Conference, New York, NY, and the Pediatric Oncology Departmen t of Ospedale Pediatrico Bambino Gesu, Rome, Italy. Patients: Thirteen patients with proliferative hemangiomas in the parotid area were trea ted medically to inhibit growth and enhance involution of the hemangio ma. Intervention: Six patients were treated with corticosteroids alone (2-1 mg/kg daily). Two patients were treated with corticosteroids (2- 4 mg/kg daily) followed by interferon alfa-2a (3 million U/m(2) daily) because of a failure to respond to corticosteroid therapy. One patien t was treated with interferon alfa-2a alone (3 million U/m(2) daily). Four patients were initially treated with interferon alfa-2a, then tre ated with corticosteroids. One of these patients required intralesiona l corticosteroid therapy for a massively enlarged lip and is therefore included in this group. The other patient was given oral corticostero ids for unknown reasons at another institution. In the remaining 2 pat ients, there was no response to the use of interferon alfa-2a. Main Ou tcome Measures: The size, bulk, and symptoms relating to the hemangiom as of the patients were assessed. Results: None of the patients had a significant improvement of the lesions of the parotid hemangiomas. In contrast, for those patients with clinical symptoms due to hemangiomas elsewhere or with cutaneous involvement typical of hemangiomas, the s ymptoms improved with either of the above therapies, and the cutaneous areas demonstrated signs of involution. Conclusions: The results in t he 13 patients in this article demonstrate that hemangiomas in certain anatomic sites, such as the parotid area, may be more resistant to th erapy with corticosteroids or interferon alfa-2a. Differences in drug metabolism, caliber of blood vessels, and/or blood flow in the parotid gland may account for this observation.