Optimal strategy of preoperative transcatheter arterial chemoembolization for hepatoblastoma.
OBJECTIVE
To investigate the optimal strategy of preoperative transcatheter arterial chemoembolization (TACE) for hepatoblastoma.


METHODS
Between 1992 and 2001, 7 children with hepatoblastoma (aged 9 months to 13 years) underwent preoperative TACE. The chemoembolic agent used was an emulsion of pirarubicin and lipiodol. Four patients without distant metastasis underwent "primary" TACE without systemic chemotherapy. The other 3 with distant metastases underwent "delayed" TACE following systemic chemotherapy. These patients were all examined retrospectively using clinical data.


RESULTS
The average dosage of lipiodol was 0.6 ml per tumor maximal diameter (cm). All the primary cases showed a significant decrease in alpha-fetoprotein (AFP) and a reduction in the tumor size. They consequently underwent a complete surgical resection and are now disease free. All the delayed cases showed a slight decrease in AFP and underwent complete surgical resection; however, two of them died of lung metastases, and the other died of a second malignancy. Regarding complications, liver dysfunction and pulmonary embolism occurred in one patient each.


CONCLUSIONS
For patients without distant metastasis, regardless of the resectability of the primary tumor, TACE may be considered the initial and only preoperative treatment, and it may be repeated. For patients with distant metastases, their complete eradication with systemic chemotherapy prior to TACE is essential.
Ohtsuka
Yasuhiro
Y
Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba 260-8677, Japan.
Matsunaga
Tadashi
T
Yoshida
Hideo
H
Kouchi
Katsunori
K
Okada
Tadao
T
Ohnuma
Naomi
N
D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage; D016461:Chemoembolization, Therapeutic; D002675:Child, Preschool; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D006498:Hepatectomy; D018197:Hepatoblastoma / Q000628:therapy*; D006801:Humans; D007223:Infant; D007459:Iodized Oil / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D011300:Preoperative Care
D000970:Antineoplastic Agents; D007459:Iodized Oil; D004317:Doxorubicin; C027260:pirarubicin