An introduction to nuclear therapy for hemangiomas

Hemangioma is a common congenital benign tumor or vascular malformation in clinical practice. It originates from residual embryonic angiogenic cells and appears on the skin, mucous membranes and other parts of the body at birth or soon after birth, and the incidence rate of infants and young children accounts for about 5%. They are classified as nevus erythematosus, simple hemangioma, cavernous hemangioma, and mixed hemangioma. Simple hemangiomas (also known as strawberry hemangiomas) are the most common type. Although hemangiomas are benign tumors, they can destroy the surrounding tissues, and in some cases grow infiltratively, resulting in cosmetic defects in children, as well as functional disorders. Some hemangiomas can also spontaneously develop complications such as ulceration, bleeding, and infection, which can even be life-threatening. Hemangioma grows rapidly, especially in the first year after birth, and the younger the age, the better the treatment effect and the higher the cure rate. Therefore, hemangioma should be discovered and treated early, and if you find hemangioma after birth, you should consult a doctor in time, and don’t treat it as a “birthmark” and let it develop, which will cause a delay of the best time for treatment. At present, the methods of treating skin and mucous membrane hemangioma include surgery, laser, freezing, sclerotherapy and radionuclide therapy of nuclear medicine department, etc. Each method has certain characteristics and limitations. Our department has adopted radionuclide treatment for hemangiomas for many years, and has accumulated rich experience and cured more than 10,000 cases of hemangioma patients. Zhao Yinlong, Department of Nuclear Medicine, The Second Hospital of Jilin University At present, there are two methods used in the Department of Nuclear Medicine for the treatment of hemangiomas, i.e., in vivo injection of 32P colloid tumors and 90Sr-90Y dressing method. Different treatment methods are selected and different treatment plans are developed according to the lesion area, site of onset, depth of lesion and age. Bright red nevus and simple hemangioma should be treated with 90Sr-90Y dressing method, which has the method of small dose and large dose; for cavernous hemangioma, mixed hemangioma and simple hemangioma with obvious protuberance, it is feasible to be treated with 32P colloid injection. if not cured in 1 course of treatment, it will be treated in 2 months and the next course of treatment will be carried out, and more than 90% of them will be cured in 1-3 courses of treatment in general. The number of treatment courses and the time interval between two courses depends on the size of the hemangioma lesion area, the diseased part, the thickness of the tumor, the patient’s sensitivity to the radiation and the response to the treatment. 90Sr and 32P are radionuclides emitting β-rays. When 90Sr-90Y dressing is placed on the lesion or 32P colloid is injected into the hemangioma tumor, the β-rays will act on the lesion tissue, causing the lesion tissue to undergo changes in morphology and function, and the endothelium of the blood vessels will be swollen, edematous, inflammatory, and atrophic, and then be replaced by the fibroblasts, and the blood vessels will be closed to achieve the therapeutic purpose. After 90Sr dressing and 32P colloid tumor in vivo injection treatment, there is generally no systemic discomfort reaction. Local reaction depends on age, diseased part, treatment dose, number of treatments and the sensitivity of the body to radiation and other factors, mostly manifested as mild edema, congestion, itching, slight burning sensation, pigmentation or loss of pigmentation, etc. In a few cases, more serious side effects such as local rupture or even ulceration can occur, which can be recovered after a few days, and pigmentation changes need to be restored to normal after a few months. After decades of follow-up observation, no side effects such as carcinogenicity of local skin rays were observed after nuclide treatment. Nuclide dressing and 32P colloid tumor in vivo injection treatment of hemangioma is simple, safe, the cure rate of more than 98%, the patient has no obvious discomfort, and occasionally leave scars. At present, it is recognized as an effective method for the treatment of skin and mucous membrane hemangioma in the medical field.