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Vielsmeier V, Schmidt VF, Obereisenbuchner F, Platz Batista da Silva N, Wohlgemuth WA, Puhr-Westerheide D, Seidensticker M, Ricke J, Kühnel T, Bohr C, Wildgruber M, Seebauer CT. Bleomycin Electrosclerotherapy (BEST) for Slow-Flow Malformations of the Upper Aerodigestive Tract. Biomedicines 2025; 13:1055. [PMID: 40426883 PMCID: PMC12109471 DOI: 10.3390/biomedicines13051055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2025] [Revised: 04/23/2025] [Accepted: 04/25/2025] [Indexed: 05/29/2025] Open
Abstract
Background/Objectives: Bleomycin electrosclerotherapy (BEST), which combines intralesional bleomycin administration with electroporation, enhances drug uptake and has shown efficacy in treating vascular malformations resistant to conventional therapies. While BEST is increasingly used in various anatomical sites, its application in the upper aerodigestive tract remains underexplored. This study evaluates the safety and effectiveness of BEST in managing slow-flow vascular malformations of the oral cavity, tongue, larynx, and hypopharynx. Methods: In this retrospective, multicenter study, 20 patients with symptomatic slow-flow vascular malformations of the upper aerodigestive tract were treated with BEST. Clinical and radiological assessments were used to evaluate the treatment response, categorized as "significantly reduced", "reduced", "stable disease", or "lesion growth". Postprocedural complications and functional outcomes were systematically recorded. Results: A total of 29 BEST sessions were performed. Lesions of the tongue (n = 8) and combined oral cavity and tongue (n = 6) showed the highest response rates, with significant symptom reduction in five out of eight and five out of six patients, respectively. Among isolated oral cavity lesions (n = 4), one out of four demonstrated a significant reduction. In contrast, laryngeal and hypopharyngeal lesions (n = 2) had limited response, with one case showing partial reduction and the other remaining stable. Severe complications, including bleeding and dyspnea requiring tracheostomy, limited further treatment in these locations. No systemic adverse events, such as pulmonary toxicity, were observed. Conclusions: BEST is effective for treating vascular malformations of the upper aerodigestive tract, particularly in the tongue and oral cavity, but presents significant risks in laryngeal and hypopharyngeal lesions. A multidisciplinary approach is required to optimize treatment protocols for these challenging locations.
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Affiliation(s)
- Veronika Vielsmeier
- Department of Otorhinolaryngology, Regensburg University Medical Center, 93053 Regensburg, Germany; (V.V.); (T.K.); (C.B.)
| | - Vanessa F. Schmidt
- Department of Radiology, LMU University Hospital, LMU Munich, 81377 München, Germany; (V.F.S.); (F.O.); (D.P.-W.); (M.S.); (J.R.); (M.W.)
| | - Florian Obereisenbuchner
- Department of Radiology, LMU University Hospital, LMU Munich, 81377 München, Germany; (V.F.S.); (F.O.); (D.P.-W.); (M.S.); (J.R.); (M.W.)
| | | | - Walter A. Wohlgemuth
- Department of Radiology and Policlinic of Radiology, University Hospital Halle (Saale), 06120 Halle (Saale), Germany;
| | - Daniel Puhr-Westerheide
- Department of Radiology, LMU University Hospital, LMU Munich, 81377 München, Germany; (V.F.S.); (F.O.); (D.P.-W.); (M.S.); (J.R.); (M.W.)
| | - Max Seidensticker
- Department of Radiology, LMU University Hospital, LMU Munich, 81377 München, Germany; (V.F.S.); (F.O.); (D.P.-W.); (M.S.); (J.R.); (M.W.)
| | - Jens Ricke
- Department of Radiology, LMU University Hospital, LMU Munich, 81377 München, Germany; (V.F.S.); (F.O.); (D.P.-W.); (M.S.); (J.R.); (M.W.)
| | - Thomas Kühnel
- Department of Otorhinolaryngology, Regensburg University Medical Center, 93053 Regensburg, Germany; (V.V.); (T.K.); (C.B.)
| | - Christopher Bohr
- Department of Otorhinolaryngology, Regensburg University Medical Center, 93053 Regensburg, Germany; (V.V.); (T.K.); (C.B.)
| | - Moritz Wildgruber
- Department of Radiology, LMU University Hospital, LMU Munich, 81377 München, Germany; (V.F.S.); (F.O.); (D.P.-W.); (M.S.); (J.R.); (M.W.)
| | - Caroline T. Seebauer
- Department of Otorhinolaryngology, Regensburg University Medical Center, 93053 Regensburg, Germany; (V.V.); (T.K.); (C.B.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, 6000 Lucerne, Switzerland
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