An open-label study to evaluate sildenafil for the treatment of lymphatic malformations

Abstract

Background: Lymphatic malformations can be challenging to treat. Mainstay interventions including surgery and sclerotherapy are invasive and can result in local recurrence and complications.

Objective: We sought to assess the effect of 20 weeks of oral sildenafil on reducing lymphatic malformation volume and symptoms in children.

Methods: Seven children (4 boys, 3 girls; ages 13-85 months) with lymphatic malformations were given oral sildenafil for 20 weeks in this open-label study. The volume of the lymphatic malformation was calculated blindly using magnetic resonance imaging performed before and after 20 weeks of sildenafil. Lymphatic malformations were assessed clinically on weeks 4, 12, 20, and 32. Both the physician and parents evaluated the lymphatic malformation in comparison with baseline.

Results: Four subjects had a lymphatic malformation volume decrease (1.0%-31.7%). In 2 subjects, despite a lymphatic malformation volume increase (1.1%-3.7%), clinical improvement was noted while on sildenafil. One subject had a 29.6% increase in lymphatic malformation volume and no therapeutic response. Lymphatic malformations of all 6 subjects who experienced a therapeutic response on sildenafil softened and became easily compressible. Adverse events were minimal.

Limitations: A randomized controlled trial will be necessary to verify the effects of sildenafil on lymphatic malformations.

Conclusions: Sildenafil can reduce lymphatic malformation volume and symptoms in some children.

Keywords: congenital; lymphatic malformation; macrocystic; magnetic resonance imaging; microcystic; phosphodiesterase-5 inhibitors; sclerotherapy.

Figure 1

Clinical Trial Diagram. MRI, magnetic resonance imaging

Figure 2

Lymphatic malformation (LM). Photographs of subject 4 at baseline (2A, 2C) and after 20-weeks of sildenafil (2B, 2D). Coronal T2-weighted fat-suppressed magnetic resonance images show a microcystic-predominant LM in the left superficial pre-mandibular and pre-maxillary soft tissues at baseline (2E) that decreased by 31.7% in volume after 20 weeks of sildenafil (2F).