Multidisciplinary treatment in children with non-metastatic hepatoblastoma: treatment results at the National Cancer Institute, Cairo University.
OBJECTIVE
The aim of this study is to evaluate our experience at the NCI, Cairo University in the management of non- metastetic hepatoblastoma (HB). Also to improve survival of children with HB and reduce the operative morbidity and mortality by using preoperative chemotherapy.


METHODS
After biopsy and assessment of the extent of disease, all patients were treated with a 6-hour continuous intravenous infusion of cisplatin (PLA) 90mg/m2 on day one followed by doxorubicin (DO) 20mg/m2 per day administered as 1- hour infusion on days 2,3 and 4. After four courses of preoperative chemotherapy, patients were reassessed. Whenever possible, the primary tumor was resected and the treatment was completed with two more courses of chemotherapy.


RESULTS
Twenty children with HB were registered between January 1999 and December 2000, the median age at diagnosis was 12 months (range, 40 days to 11 years). All the 20 patients had received preoperative chemotherapy (PLADO). Fifteen patients (75%) showed partial response with tumor shrinkage and serial decrease of serum alpha-fetoprotein levels. Sixteen patients underwent surgery, fourteen of them had complete resection of the primary tumor (87.5%). The median duration of followup was 26 months (range 1-55 months). The three year disease-free survival was 68.4% and event-free survival was 65%.


CONCLUSIONS
We can advocate the use of PLADO chemotherapy and delayed surgery to be the standard treatment for children with HB. Other treatment programs should be measured against this standard.
Zamzam
Manal A
MA
Department of Pediatric Oncology, National Cancer Institute, Cairo University.
Elmalt
Osama
O
Aboul Kassem
Hatem
H
Nouh
Akram
A
El-Basmy
Amany
A