Liver transplantation for malignant liver tumors in children

Dower, Nancy A.; Smith, Lesley

doi:10.1002/(sici)1096-911x(200002)34:2<136::aid-mpo12>3.0.co;2-a

Cited by 23 publications

(19 citation statements)

References 42 publications

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“…[7][8][9][10][11][12][13][14][15][16][17][18][19][20] Liver transplantation has been performed for non-resectable tumours, [21] or for recurrent disease after previous resection, and has been suggested to offer more likelihood of cure than adding radiation. [22] Five such patients have been documented with claimed disease-free survival from 18 months to 5 years.…”

Section: Discussionmentioning

confidence: 99%

“…[22] Five such patients have been documented with claimed disease-free survival from 18 months to 5 years. [21][22][23][24] This encouraging therapeutic option must be thoroughly evaluated with larger numbers of subjects before more valid conclusions can be drawn, particularly as it has been suggested that poor outcomes in patients with malignancies do not justify the use of scarce organs for transplantation. [25] UESL is an aggressive malignancy that is prone to local recurrence and, less often, distant metastatic spread.…”

Section: Discussionmentioning

confidence: 99%

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Management of undifferentiated embryonal sarcoma of the liver in children: A case series and management review

et al. 2013

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Background. Undifferentiated embryonal sarcoma of the liver (UESL) is a rare neoplasm, and the third-most common paediatric hepatic malignancy. However, no treatment guidelines exist. No randomised, controlled trials support specific combinations of therapy. Objective. To compare presentation and management of UESL with other series, review the literature, and formulate treatment guidelines. Methods. A retrospective chart review of all hepatic malignancies was conducted from 1996 to 2007 and 5 children with UESL were identified. Management and outcomes were documented. The literature regarding treatment modalities up to September 2012 was reviewed. Results. Over a period of 11 years, 5 patients presented. All underwent surgery and 4 received chemotherapy. One received radiotherapy at relapse. Three are disease-free with follow-up of 58 -184 months. One died after relapse, as did the patient whose family declined chemotherapy. Conclusion. The improved outcomes are consistent with the international experience and are probably related to combined treatment modalities and advances in supportive care. Pre-operative percutaneous biopsy provides no benefit if the lesion is resectable because it may not prove to be diagnostic, and may cause recurrence in the biopsy tract. If resectable, the recommended treatment is primary excision and adjuvant chemotherapy, with radiotherapy in selected cases. If unresectable, open biopsy is necessary to document histology, and neoadjuvant chemotherapy is given prior to resection. If deemed unresectable, liver transplantation is considered.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of undifferentiated embryonal sarcoma of the liver in children: A case series and management review

et al. 2013

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“…In a recent review of the literature on transplantation in hepatoblastoma, Dower and Smith [49] reported on 33 stage III and 39 stage IV tumors. In patients transplanted with stage III tumors, disease-free survival (DFS) with minimum follow-up of one year is 72%.…”

Section: Treatment Surgerymentioning

confidence: 99%

Childhood Cancers: Hepatoblastoma

2000

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Hepatoblastoma is the most common primary liver tumor in children, accounting for just over 1% of pediatric cancers. The etiology is unknown, but it has been associated with Beckwith-Weidemann syndrome, familial adenomatosis polypi, and low birth weight. The primary treatment is surgical resection, however, chemotherapy plays an important role by increasing the number of tumors that are resectable. The prognosis for patients with resectable tumors is fairly good, however, the outcome for those with nonresectable or recurrent disease is poor. Texas-Houston Medical School, 1515 Holcombe Blvd., Houston, Texas 77030, USA. Telephone: 713-745-0157; Fax 713-792-0608; e-mail: cherzog@ mdanderson.org Received June 21, 2000; accepted for publication September 6, 2000. ©AlphaMed Press 1083-7159/2000 INTRODUCTIONHepatoblastoma is the most common malignant tumor of the liver in children. Surgery remains the primary means of curative therapy, but the role of chemotherapy in both the adjuvant and neoadjuvant setting has become increasingly important over the past three decades. New insight has also been gained into the molecular biology of hepatoblastoma.

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“…6 However, approximately 20% of tumors remain unresectable after chemotherapy; for these, liver transplantation has been used in the absence of visible extrahepatic disease. [7][8][9] Early reports of liver transplantation for children with unresectable HB reported a 50% 5-year survival rate, with tumor recurrence being the most common cause of death. 9,10 More recently survival has improved to approximately 80% at 5 years post-transplantation.…”

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confidence: 99%

Liver transplantation for hepatoblastoma

et al. 2008

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From October 1993 to February 2007, 25 liver transplantations were performed for hepatoblastoma. Of these 25, 18 children received cadaveric grafts, and 7 received left lateral segments from living donors. Fifteen patients were at level IV in the pretreatment extent of disease staging system for hepatoblastoma (PRETEXT IV; 11 received cadaveric grafts and 4 underwent living related liver transplantation [LRLT]) and 10 were level III (PRETEXT III; 7 received cadaveric grafts and 3 underwent LRLT). Preoperative chemotherapy was given according to the risk stratification system for children with hepatoblastoma protocols of the International Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL): SIOPEL I in the first 3 patients, SIOPEL II in 6, SIOPEL III in 10, and SIOPEL IV in 3 patients. Patient and graft survival after cadaveric transplantation was 91%, 77.6%, and 77.6%, at 1, 5, and 10 years, respectively, with no retransplantations. Patient and graft survival for children undergoing LRLT was 100%, 83.3%, and 83.3%, at 1, 5, and 10 years, respectively. All surviving children but 1 remain disease‐free, with a median follow up of 6.8 years (range, 0.9‐14.9). There were 5 deaths at a median of 13 months post‐transplantation, secondary to tumor recurrence (4) and respiratory failure (1). Liver transplantation is an established treatment for unresectable hepatoblastoma confined to the liver following chemotherapy. LRLT is a therapeutic option given that the outcome is similar to that of resection and cadaveric transplantation. Liver Transpl 14:1614–1619, 2008. © 2008 AASLD.

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Liver transplantation for malignant liver tumors in children

Cited by 23 publications

References 42 publications

Management of undifferentiated embryonal sarcoma of the liver in children: A case series and management review

Management of undifferentiated embryonal sarcoma of the liver in children: A case series and management review

Childhood Cancers: Hepatoblastoma

Liver transplantation for hepatoblastoma

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