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[Multidisciplinary management of malignant hepatic tumors in children: a recent national experience]
J M Herrera1, F Barriga, P Harris
1Departamento de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Insights
Multidisciplinary management effectively treats pediatric malignant hepatic tumors, including hepatoblastoma and metastatic Wilms tumor. This approach combines chemotherapy and surgery, leading to complete resection and disease-free survival in all patients.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Medical Oncology
Context:
- Malignant hepatic tumors (Mht) are rare in children, with hepatoblastoma (HB) being the most common.
- This study focuses on 6 pediatric patients with malignant hepatic tumors.
Purpose:
- To report the outcomes of a multidisciplinary management strategy for pediatric malignant hepatic tumors.
- To evaluate the effectiveness of combined chemotherapy and surgical resection.
Summary:
- Five patients had hepatoblastoma (HB) and one had metastatic Wilms tumor (MWT).
- All patients received neoadjuvant chemotherapy followed by surgical resection (hepatectomies, central resection, or segmentectomy).
- Complete resection with negative margins was achieved in all cases, with 60-90% tumor necrosis observed post-chemotherapy.
Impact:
- The multidisciplinary approach resulted in complete tumor resection and disease-free survival for all patients.
- This strategy highlights the efficacy of timely chemotherapy and surgery in managing pediatric malignant hepatic tumors.
- Alfafetoprotein levels normalized in HB cases post-surgery, indicating treatment response.
Background:
Malignant hepatic tumors (Mht) are rare in children. Among them hepatoblastoma (HB) is the most common.
Aim:
To report the results of the multidisciplinary management in 6 consecutive children: five HB and one metastatic Wilms tumor (MWT).
Patients And Methods:
The mean age of patients was 42 months. All HB patients had elevated serum alfafetoprotein (median 150,000 ng/ml). All patients received preoperative chemotherapy: HB patients received carboplatin/doxorubicin alternating with cisplatin, and the MWT patient, vincristine alone. Surgery included two formal right and two formal left hepatectomies, one extensive central resection with partial left segmentectomy, and one lateral segmentectomy. Extracorporeal circulation was used in the child with atrial involvement. All patients received postoperative chemotherapy.
Results:
All tumors had variable regresion on preoperative chemotherapy. Complete resection with negative margins was achieved in all patients. The degree of tumor necrosis on histology ranged from 60% to 90%. Alfafetoprotein levels fell to under 10 ng/ml in all HB cases, one to three months after surgery. All patients survive free of disease at a median follow up of 19 months.
Conclusion:
A multidisciplinary approach including the well timed used of chemotherapy and surgery is highly effective in the management of pediatric malignant tumors.