title: High-dose chemotherapy in children with metastatic hepatoblastoma.
abstract: 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.
authors: Department of Pediatrics, School of Medicine, Hiroshima University, Hiroshima, Japan. snishimu@hiroshima-u.ac.jp
authors: Shin-Ichiro
authors: S
authors: Nishimura
authors: Takashi
authors: T
authors: Sato
authors: Naoto
authors: N
authors: Fujita
authors: Hiroaki
authors: H
authors: Yamaoka
authors: Eiso
authors: E
authors: Hiyama
authors: Takashi
authors: T
authors: Yokoyama
authors: Kazuhiro
authors: K
authors: Ueda
mesh_terms: 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