Infantile hemangiomas, benign tumors that are among the most prevalent of vascular anomalies in children, have commanded significant medical attention and research over the past several decades. The Royal Belfast Hospital for Sick Children and Ulster Hospital has stood at the forefront in the regional treatment of this condition, contributing to the evolution of therapeutic strategies.
In a recent issue of The Ulster Medical Journal, Ho Weiguang and colleagues from the Department of Plastic Surgery at this leading regional medical center in Belfast, Northern Ireland, provided an insightful perspective on the treatment of infantile hemangioma. This benchmark paper, published in May 2019, can be accessed via the DOI: 10.1002/umj.31061558.
Drawing upon a robust mix of treatment modalities endorsed by the International Society for the Study of Vascular Anomalies (ISSVA), the Belfast team’s approach has been multidisciplinary. The ISVVA’s vascular anomalies classification system provides a framework for differentiating vascular anomalies and guides clinicians in therapy choices (Wassef et al., 2015). This medical centre has particularly excelled in two areas: the pharmacological use of vasodilator agents, like propranolol, and the surgical treatment of hemangiomas.
Propranolol: A Tipping Point in Hemangioma Treatment
The Belfast team has seen significant success using propranolol, a non-selective beta-blocker, to treat infantile hemangioma. Prior to the discovery of propranolol’s efficacy, treatment options were limited, often involving invasive and sometimes disfiguring surgeries or prolonged corticosteroid therapy with substantial side effects.
Ho and co-authors have articulated the pivotal change that propranolol represented when first introduced. The comprehensive reviews by Léauté-Labrèze et al. (2008) and Starkey and Shahidullah (2011) affirmed its dramatic effect on stopping hemangioma growth and promoting regression. The evidence solidified propranolol’s position as a first-line treatment, considerably altering the therapeutic landscape (Schwartz et al., 2009; Storch & Hoeger, 2010).
Surgical Intervention: A Balancing Act
Despite the breakthrough with propranolol, surgery remains a key tool, especially in cases where pharmacological treatment fails or is contraindicated. The surgical expertise at the Royal Belfast Hospital for Sick Children and Ulster Hospital has refined techniques for minimizing scarring and optimizing outcomes. The delicate balance between medical management and surgical intervention necessitates an individualized approach to each case, as echoed by the collaborative philosophy promoted by the ISSVA (Mulliken & Glowacki, 1982; Wassef et al., 2015).
Retrospective Vision for Future Management
Retrospective studies have provided essential data for advancing hemangioma treatment. Ho and his team have leveraged such analyses, which have underscored the need for treatment protocols that reduce the risk of adverse effects associated with pharmacological agents like propranolol (Marqueling et al., 2013; McGee et al., 2013). Moreover, Tangtatco et al. (2018) pointed out the importance of evaluating the role of previous medical treatments when considering surgical options.
Collaborative and Consensus-Based Approach
Adoption of a consensus-based approach, analogous to that enacted in specialized centers like Great Ormond Street Hospital in London, has enabled the Royal Belfast Hospital to align with international standards in hemangioma treatment (NHS Great Ormond Street Hospital). Furthermore, regional guidelines established across various healthcare systems have informed best practices, such as those disseminated by the Government of South Australia’s Department of Health and the National Institute for Health and Care Excellence (NICE) in London.
Conclusion
The Belfast team’s study reinforces the significance of embracing a holistic and adaptable treatment regimen for infantile hemangioma. Drawing from robust global discourse and evidence-based strategy adaptations, the Royal Belfast Hospital for Sick Children and Ulster Hospital has demonstrated the dynamic nature of hemangioma management. With the essence of their perspective centered on individual patient-needs, the continuing journey to refine treatment protocols is as ever-evolving as the field of medical science itself.
References
1. Ho W., et al. (2019). Treatment of Infantile Haemangioma – Perspective of a Regional Surgical Centre. Ulster Med J, 88(2), 102-104. PMC6500410
2. Zimmermann A.P., et al. (2010). Propranolol therapy for infantile haemangiomas: review of the literature. Int J Pediatr Otorhinolaryngol, 74(4), 338–42. DOI: 10.1016/j.ijporl.2010.01.013
3. Wassef M., et al. (2015). Vascular anomalies classification: recommendations from the International Society for the Study of Vascular Anomalies. Pediatrics, 136(1), e203–14. DOI: 10.1542/peds.2014-3673
4. Mulliken J.B., & Glowacki J. (1982). Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg, 69(3), 412–22. DOI: 10.1097/00006534-198203000-00002
5. Marqueling A.L., et al. (2013). Propranolol and infantile hemangiomas four years later: a systematic review. Pediatr Dermatol, 30(2), 182–91. DOI: 10.1111/pde.12089
Keywords
1. Infantile Hemangioma Treatment
2. Propranolol for Hemangioma
3. Surgical Treatment of Hemangioma
4. Belfast Regional Medical Centre
5. Vascular Anomalies Management