High-dose chemotherapy in children with metastatic hepatoblastoma.
BACKGROUND
Despite the advent of effective chemotherapy,a poor prognosis has been reported for patients with metastatic hepatoblastoma. To improve this prognosis, we conducted high-dose chemotherapy with autologous bone marrow rescue in patients with metastatic hepatoblastoma.


RESULTS
Three patients were treated with high-dose chemotherapy. In patient 1, high-dose chemotherapy was given after the patient's first pulmonary relapse. Additional pulmonary metastases, which developed more than 6 months after high-dose chemotherapy, were treated by multiple thoracotomy without additional chemotherapy. Patient 2 presented additional pulmonary metastases soon after the end of the first thoracotomy and high-dose chemotherapy. Because of a decreased serum alpha-fetoprotein level after re-excision of the pulmonary metastases, a second round of high-dose chemotherapy was performed. In patient 3, multiple pulmonary metasteses responded to preoperative chemotherapy and disappeared according to the chest computed tomography. Intensive treatment with a high-dose chemotherapeutic regimen was performed at the end of postoperative chemotherapy. All three patients are alive and well, more than 6 years after receiving their diagnosis.


CONCLUSIONS
The role of high-dose chemotherapy in treatment of metastatic hepatoblastoma could not be clarified,because of the small number of patients. However, the better outcome of our patients indicates that multimodal therapy, including high-dose chemotherapy, may improve the outcome of the patients with metastatic hepatoblastoma.
Nishimura
Shin-Ichiro
S
Department of Pediatrics, School of Medicine, Hiroshima University, Hiroshima, Japan. snishimu@hiroshima-u.ac.jp
Sato
Takashi
T
Fujita
Naoto
N
Yamaoka
Hiroaki
H
Hiyama
Eiso
E
Yokoyama
Takashi
T
Ueda
Kazuhiro
K
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D018197:Hepatoblastoma / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000473:pathology*; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D008297:Male; D011013:Pneumonectomy; D011379:Prognosis