The Treatment of Hemangioma

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Abstract
Many excellent papers have been written on the treatment of hemangioma. In nearly all of them the advantages of some particular method of treatment have been extolled. This paper is based on experience with 520 cases. Its object is to show the advantage of selecting the form of treatment according to the conditions present. The method of treatment of hemangioma should vary with the type or character of the lesion, its size, its location, and the age of the patient. I am, therefore, not advocating any particular method of therapy for all cases. I shall try to present the indications for each type of treatment, and demonstrate some of the results which I have obtained by each. I have found no satisfactory treatment for the portwine type. In these, x-rays have produced atrophy and telangiectasis; radium does the same, and, in addition, the appearance is apt to be blotchy; electrodesiccation gives scarring, and in at least one case I had to treat a keloid afterward. As radiologists, we naturally think first of treatment with radium and/or x-rays (Andren, Andrews, Pohle, Brown, Mac-Kee, Schmidt, Baensch, Nielsen, Harwell). Hodges has especially recommended treatment as early as possible. In general, and for the greatest number of cases, I believe that radium is the most useful, especially when the lesions are relatively superficial—not more than 1 or 2 cm. in depth. I have in some cases used both radium and x-rays in the same case. Some good results have been obtained and reported by various authors with each kind of radiation—high voltage and high filtration, low voltage and moderate filtration, and contact therapy with very low voltage and little filtration (Hodges, Kerr, Pendergrass, and others). Radium: Indications and Advantages Treatment with radium is indicated especially in children, because it can be applied without pain and without an anesthetic and can be retained by adhesive plaster without immobilizing the patient. In addition, the after treatment requires no dressings and no other special measures. Even in adults, most of these advantages exist. Generally, hemangiomata of the cavernous and strawberry types are relatively superficial. It is to these types that this paper refers. It is always desirable to limit depth dosage as much as possible, when it is not needed. I am convinced that it is neither desirable nor, indeed, entirely harmless to irradiate normal tissue when it can be avoided, and I always try, so far as is possible, to confine irradiation to the diseased tissue. This is why careful diagnosis and good clinical judgment are necessary in radiation therapy, and why it cannot be turned over to technicians. Medical training is essential. Radium has, relatively, a local and superficial effect. The inverse-square law applies but is complicated by the fact that one must usually use multiple foci.

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