Preliminary experience with arterial chemoembolization for hepatoblastoma and hepatocellular carcinoma in children

Abstract

The objective of this work was to test feasibility and efficacy of hepatic artery chemoembolization (HACE) in unresectable malignant liver tumors. Five patients aged from 1-12 years were treated in the Medical University of Gdansk from 1999 to 2002. All had locally advanced tumors, which did not respond to systemic chemotherapy: four, hepatoblastoma (HB) and one, hepatocellular carcinoma (HCC). Arteriography was performed and chemoembolization suspension (cisplatin + doxorubicin + mitomycin mixed with lipiodol) was injected, followed by gelatin foam particles. The procedure was performed one to three times in each patient. In four patients (three, HB, one, fibrolamellar HCC), tumor response was observed, with decrease in the diameter of the mass of 25-33% and fall in the AFP level of 83-99%. One child with HB was non-evaluable due to early death caused by systemic myelotoxicity. Two patients (2 HB) underwent macroscopically complete tumor resection, 1 is alive and well, and 1 died at the end of surgery for an unknown reason (possibly related to cardiotoxicity of earlier systemic chemotherapy). One HB patient was successfully transplanted after two HACE courses. The only HCC patient died because of pulmonary oil embolism immediately after the third HACE course. HACE can lead to tumor regression in most cases and may be considered an alternative for patients with unresectable liver tumors who do not respond to primary systemic chemotherapy and are not candidates for liver transplantation for various reasons.

Pediatric hepatocellular carcinoma: challenges and solutions

“…The conclusion was that TACE with a suspension of cisplatin, doxorubicin, and mitomycin mixed with lipiodol is feasible, well-tolerated, and effective in achieving surgical resectability in pediatric patients. These encouraging results were confirmed by Czauderna et al56 (five patients, 1–12 years old, one with HCC).…”

Hepatic artery thrombosis and liver malignancy in pediatric liver transplantation

“…Interestingly, we failed to see a difference in TEG values between the 2 groups. In addition, children transplanted for liver malignancy consistently receive neoadjuvant chemotherapy and occasionally receive intrahepatic chemoembolization [11,12,[14][15][16]. Although data regarding arterial thrombosis and chemotherapy for hepatic malignancy are scarce, both neoadjuvant chemotherapy and arterial chemoembolization may confer an increased risk of HAT in these patients.…”

Hepatoblastoma state of the art

“…Of the 23 evaluable patients, 6 had a partial response, 11 had stable disease, and 6 had progressive disease. Hepatic intra-arterial chemoembolization has been shown to be efficacious in shrinking these tumors and allowing complete surgical resection after initial systemic chemotherapy [53,54]. Highdose chemotherapy with stem cell rescue has been used in the setting of progressive or relapsed hepatoblastoma.…”