Use of Intrahepatic Chemotherapy to Treat Advanced Pediatric Hepatic Malignancies

Abstract

Intrahepatic arterial chemotherapy therapy can halt the progression and possibly down-stage advanced pediatric hepatic malignancies. This therapy can also be used as a successful adjunct in altering a patient's chance for successful liver transplantation.

Transarterial chemoembolization in children to treat unresectable hepatocellular carcinoma

“…As the best cure rates have been shown with surgical resection and transplantation, all efforts should be made to make these options available for pediatric patients with HCC . While several groups have reported that TACE is feasible in children, the published experience is limited primarily to small case series of patients with HB, not HCC . Our experience with HCC is similar to the HB TACE literature, in which patients were generally bridged to surgical resection and had a low incidence of severe complications …”

Successful treatment of progressive stage 4s hepatic neuroblastoma in a neonate with intra‐arterial chemoembolization

“…Furthermore, in our case, a single course of chemoembolization arrested tumor growth, followed by involution of the liver to normal. In both series reporting on the use of hepatic chemoembolization in children with primary liver tumors, multiple cycles were administered with no significant toxicity 13,14. Moreover, in the report by Malogolowokin et al, plasma levels of cisplatinum and doxorubicin were undetectable following HACE in all the pediatric patients sampled, suggesting significant first pass metabolism of the drugs in the liver, and accounting perhaps for the minimal systemic toxicity.…”

“…Multiple cycles were administered with minimal toxicity. Five of eleven patients were rendered eligible for orthoptic liver transplantation (OLT) following this treatment 14.…”

“…Using a two to three French coaxial catheter the right hepatic artery was selected. After cannulation, a solution containing 10 mg of cis ‐platinum and 7 mg of doxorubicin was slowly injected over 30 min 14. Following injection of chemotherapy, embolization was achieved using polyvinyl alcohol (PVA) particles 155–250 microns diameter (Cook, Inc.) until cessation of flow in the vessel was observed (Fig.…”

Recent advances in pediatric liver transplantation

“…Their tumors are typically partially responsive to chemotherapy, and the children have typically undergone four or more cycles of chemotherapy prior to transplantation [42]. Intrahepatic arterial chemotherapy may provide additional benefits [43]. Postoperative attention to the risk of recurrent or metastatic disease is extremely important.…”