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Intrahepatic chemoembolization in unresectable pediatric liver malignancies
C M Arcement1, R B Towbin, M P Meza
1Department of Radiology, Children's Hospital at Pittsburgh, PA 15213, USA. mezam@chplink.chp.edu
Pediatric Radiology
|December 2, 2000
Summary
Neoadjuvant intrahepatic chemoembolization (IHCE) combined with liver transplant (OLTx) shows promise for treating unresectable liver tumors in children who failed chemotherapy. This multidisciplinary approach can lead to cures in select cases.
Area of Science:
- Pediatric Oncology
- Hepatobiliary Surgery
- Interventional Radiology
Background:
- Unresectable hepatic tumors in children often have poor prognoses, especially after failure of systemic chemotherapy.
- Multidisciplinary treatment strategies are crucial for managing complex pediatric liver cancers.
- Neoadjuvant therapies aim to downstage tumors, making them amenable to surgical resection or transplantation.
Purpose of the Study:
- To evaluate the effectiveness of a combined neoadjuvant intrahepatic chemoembolization (IHCE) and orthotopic liver transplant (OLTx) protocol.
- To assess the feasibility of IHCE in converting unresectable hepatic tumors to transplantable lesions.
- To determine the role of alpha-fetoprotein and imaging in monitoring treatment response.
Main Methods:
- A cohort of 14 children with unresectable hepatic tumors who failed systemic chemotherapy were treated.
- The treatment involved intra-arterial chemotherapy with cisplatin and/or adriamycin, often combined with gelfoam embolization (IHCE).
- Procedures were repeated every 3-4 weeks, with serial contrast-enhanced CT scans and alpha-fetoprotein level monitoring.
Main Results:
- Six of 14 patients underwent OLTx. Three of these patients remain disease-free post-transplant.
- Tumor response varied, with some patients showing decreased tumor size and alpha-fetoprotein levels, while others progressed or developed metastatic disease.
- Complications included hepatic artery thrombosis and a gastric ulcer; IHCE did not render unresectable lesions amenable to partial hepatectomy.
Conclusions:
- The combination of IHCE and OLTx offers a promising therapeutic option for select pediatric patients with unresectable hepatic tumors resistant to systemic therapy.
- Alpha-fetoprotein levels and cross-sectional imaging are valuable, complementary tools for assessing treatment efficacy.
- IHCE is not a substitute for resection in cases where lesions remain anatomically unresectable.