Clinical outcome of pingyangmycin–polidocanol foam versus pingyangmycin alone in pediatric cystic lymphatic malformation with intracapsular hemorrhage: A retrospective cohort study

Cystic lymphatic malformations (CLMs) with intracapsular hemorrhage present a management challenge. This study aimed to describe and compare the clinical outcomes associated with pingyangmycin-polidocanol foam (PPF) versus pingyangmycin (PYM) sclerotherapy in this pediatric population. A retrospective cohort study was conducted on 74 pediatric patients with CLMs and intracapsular hemorrhage treated between October 2020 and May 2023. Patients were treated with either PPF (n = 37) or PYM (n = 37). The primary outcomes were lesion volume reduction grading, number of treatment sessions, pain relief, and family satisfaction. Secondary outcomes included adverse effects and recurrence. Factors associated with treatment response were explored. Baseline characteristics were comparable between groups. Children in the PPF group exhibited a greater median reduction in lesion volume after the first session (23.0 cm3 vs 12.2 cm3, P = .028) and received fewer median treatment sessions (2 vs 3, P = .023) compared with those in the PYM group. A higher proportion in the PPF group achieved a good response (Achauer grade III/IV) after the final treatment (83.8% vs 73.0%, P = .020) and reported complete pain relief (73.6% vs 41.7%, P = .036). Family satisfaction scores were significantly higher in the PPF group (P = .020). There were no significant differences in overall adverse event rates (18.9% vs 27.0%, P = .407) or recurrence rates (21.6% vs 27.0%, P = .787). Multivariable analysis confirmed that PPF treatment and macrocystic/mixed lesion type were independent factors associated with a good response. An increased number of treatment sessions was associated with more adverse effects but lower recurrence. In this retrospective analysis, PPF sclerotherapy was associated with a greater initial volume reduction, fewer treatment sessions, and higher family satisfaction compared with PYM alone in pediatric CLMs with intracapsular hemorrhage. Macrocystic and mixed lesions showed better response to PPF. Prospective studies are warranted to validate these findings.