title: Liver transplantation and chemotherapy for hepatoblastoma and hepatocellular cancer in childhood and adolescence.
abstract: OBJECTIVE
  To describe our experience with total hepatectomy and liver transplantation as treatment for primary hepatoblastoma (HBL) and hepatocellular carcinoma (HCC) in children.
  
  
  METHODS
  A retrospective analysis of the perioperative course of 31 children with unresectable primary HBL (n = 12) and HCC (n = 19) who underwent transplantation between May 1989 and December 1998. Systemic (n = 18) and intraarterial (n = 7) neoadjuvant chemotherapy were administered; follow-up ranged from 1 to 185 months.
  
  
  RESULTS
  For HBL, 1-year, 3-year, and 5-year posttransplantation survival rates were 92%, 92%, and 83%, respectively. Intravenous invasion, positive hilar lymph nodes, and contiguous spread did not have a significant adverse effect on outcome; distant metastasis was responsible for 2 deaths. Intraarterial chemotherapy was effective in all patients treated. For HCC, the overall 1-year, 3-year, and 5-year disease-free survival rates were 79%, 68%, and 63%, respectively. Vascular invasion, distant metastases, lymph node involvement, tumor size, and gender were significant risk factors for recurrence. Intraarterial chemotherapy was effective in 1 of 3 patients. Six patients died of recurrent HCC, and 3 deaths were unrelated to recurrent tumor.
  
  
  CONCLUSIONS
  Liver transplantation for unresectable HBL and HCC can be curative. Risk factors for recurrence were significant only for HCC, with more advanced stages amenable to cure in the HBL group.
authors.affiliation: University of Pittsburgh, Thomas E. Starzl Transplantation Institute, PA, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Reyes
authors.forename: B
authors.initials: B
authors.lastname: Carr
authors.forename: I
authors.initials: I
authors.lastname: Dvorchik
authors.forename: S
authors.initials: S
authors.lastname: Kocoshis
authors.forename: R
authors.initials: R
authors.lastname: Jaffe
authors.forename: D
authors.initials: D
authors.lastname: Gerber
authors.forename: G V
authors.initials: GV
authors.lastname: Mazariegos
authors.forename: J
authors.initials: J
authors.lastname: Bueno
authors.forename: R
authors.initials: R
authors.lastname: Selby
mesh_terms: D000293:Adolescent; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D018197:Hepatoblastoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate