Combined treatment of hepatoblastoma with transcatheter arterial chemoembolization and surgery.
Hepatoblastoma (HB) frequently presents at an advanced and unresectable stage. Transcatheter arterial chemoembolization (TACE) had been attempted to improve the feasibility of removing the bulky tumor in the authors' hospital and the results were presented here to evaluate the effectiveness and therapeutic role of TACE in the HB infants. Eight patients (6 boys, 2 girls), ranging in age from 2 months to 12 months, had unresectable HB based on clinical manifestation, B-ultrasound (B-US), chest X-ray film, computed tomography (CT), blood chemistry, and serum alpha-fetoprotein (AFP), and were subjected to TACE 1-3 times. On each TACE, Adriamycin (ADR, 20 mg/m2), vincristine (VCR, 1.5 mg/m2), and cisplatin (CDDP, 40 mg/m2) dispersed in 5-10 mL lipiodol were infused into the tumor, and stainless-steel embolization coils were released into the main feeding artery until completely embolized. Then, all the patients were reexamined once a month. Digital subtractive angiography was performed and the therapeutic strategy of further TACE or surgery was individualized in terms of the changes of tumor stain and the newly forming feeding artery. Six children (75%) had a marked response after the first TACE and were judged as being surgically resectable, but one boy died of pneumonia just before the scheduled operation and another boy preferred further TACE. The other 2 patients had only a partial response and required further TACE before the operation. Thus 6 children eventually underwent complete surgical resection and 1 boy achieved successful disappearance of tumor after 3 episodes of TACE alone. Seven children had an excellent recovery and remained tumor-free for 15-49 months. The results indicate that TACE is an effective and useful preoperative therapeutic choice for unresectable hepatoblastoma, and can improve the resectablity of the bulky tumor and the survival rate of HB patients. Multiple TACE could enhance the therapeutic effect and should be considered if indicated.
Xuewu
Jiang
J
Department of Pediatric Surgery, The Second Hospital of Shantou University Medical College, Shantou, China. jiangxw@sina.com
Jianhong
Li
L
Xianliang
Hu
H
Zhongxian
Chen
C
D000792:Angiography; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D018197:Hepatoblastoma / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D014750:Vincristine; D004317:Doxorubicin; D002945:Cisplatin