Richard J. H. Smith, M.D.
Professor and Vice Chairman
Department of Otolaryngology, University of Iowa
I first met Dr. Shuhei Ogita in the early 199s although I had been in correspondence with him for several years before his visit to Iowa City. He presented a lecture at the Annual Iowa Head and Neck Cancer and Reconstructive Surgery Course that was exceptional both for its scientific quality and its potential to change the treatment of lymphatic malformations. These relatively rare congenital malformations of the lymphatic system are typically diagnosed in children younger than two years of age. Occasionally, spontaneous resolution occurs but more often these huge and grossly deforming lesions do not resolve. Surgical excision with careful preservation of involved neural and vascular structures is required. With complete excision, recurrences are not common, but in the majority of cases, lymphatic malformations cannot be completely removed without significant morbidity. As a result, significant regrowth occurs in one-third of children.
Like all physicians who care for children with lymphatic malformations, Dr. Ogita was frustrated by these facts and in the mid 1980s explored the use of OK-432 as an alternative form of therapy. OK-432 is produced by the lyophilization of the low-virulence Su strain of group A Streptococcus pyogenes that is treated with penicillin G potassium. In 1975, the Japanese Ministry of Health and Welfare approved it for use as a biological response modifier in patients with cancers, and 1987, Dr. Ogita reported the use of OK-432 in the treatment of nine children with macrosystic lymphangiomas. Complete regression was observed in eight of these children within 2-3 months after therapy, although three children required more than one injection to achieve a response.
Prompted by this success, Dr. Ogita offered this treatment to additional patients and kindly encouraged us to embark on a multi-institutional nation-wide study in the United States. Preliminary results of this study and of studies performed in other countries show that OK-432-induced sclerosis of macrosystic lymphatic malformations results in complete regression of lesions in the majority of children. When compared to surgical therapy, OK-432 is more efficacious and at a lower morbidity and lower cost.
It is tragic loss to medicine that Dr. Ogita died at such a young age but his legacy lives in the faces of children seen every week for the treatment of macrosystic lymphatic malformations. Dr. Ogita has changed the paradigm for the management of this disease, and in his typically quiet, compassionate, and caring way he continues to touch us all.