The response of parotid hemangiomas to the use of systemic interferon alfa-2a or corticosteroids.

OBJECTIVE: To evaluate medical treatment for hemangiomas involving the parotid area with or without other areas of involvement.

DESIGN: Retrospective analysis of pediatric patients treated medically for proliferative hemangiomas of the parotid region with or without hemangiomas in other regions. Indications for treatment included respiratory symptoms relating to hemangiomas of the upper airway, difficulty feeding, rapid rate of growth of the hemangioma, and deformity or obstruction of the ear canal.

SETTING: New York University Multidisciplinary Vascular Anomaly Conference, New York, NY, and the Pediatric Oncology Department of Ospedale Pediatrico Bambino Gesu, Rome, Italy.

PATIENTS: Thirteen patients with proliferative hemangiomas in the parotid area were treated medically to inhibit growth and enhance involution of the hemangioma.

INTERVENTION: Six patients were treated with corticosteroids alone (2-4 mg/kg daily). Two patients were treated with corticosteroids (2-4 mg/kg daily) followed by interferon alfa-2a (3 million U/m2 daily) because of a failure to respond to corticosteroid therapy. One patient was treated with interferon alfa-2a alone (3 million U/m2 daily). Four patients were initially treated with interferon alfa-2a, then treated with corticosteroids. One of these patients required intralesional corticosteroid therapy for a massively enlarged lip and is therefore included in this group. The other patient was given oral corticosteroids for unknown reasons at another institution. In the remaining 2 patients, there was no response to the use of interferon alfa-2a.

MAIN OUTCOME MEASURES: The size, bulk, and symptoms relating to the hemangiomas 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 symptoms improved with either of the above therapies, and the cutaneous areas demonstrated signs of involution.

CONCLUSIONS: The results in the 13 patients in this article demonstrate that hemangiomas in certain anatomic sites, such as the parotid area, may be more resistant to therapy 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.