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Chemotherapy can convert unresectable hepatoblastoma
M Reynolds1, E C Douglass, M Finegold
1Children's Memorial Hospital, Chicago, IL.
Journal of Pediatric Surgery
|August 1, 1992
Summary
Preoperative chemotherapy enables successful resection of initially unresectable hepatoblastoma in children. This approach improves outcomes for pediatric cancer patients, avoiding risky primary surgery.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Hepatobiliary Malignancies
Background:
- Hepatoblastoma management has evolved with advanced imaging and neoadjuvant chemotherapy.
- Pediatric Oncology Group (POG) Study no. 8697 evaluated treatment strategies for hepatoblastoma.
Purpose of the Study:
- To assess the efficacy of preoperative chemotherapy in enabling surgical resection of initially unresectable hepatoblastoma.
- To compare outcomes between primary tumor resection and delayed resection after neoadjuvant chemotherapy.
Main Methods:
- Retrospective analysis of 63 pediatric hepatoblastoma patients (1986-1991).
- Group I: Primary resection followed by chemotherapy (cisplatin, vincristine, 5-fluorouracil).
- Group II: Preoperative chemotherapy for unresectable tumors, followed by delayed resection if responsive.
Main Results:
- 77% complete remission in both groups after 13-54 months.
- Preoperative chemotherapy allowed delayed resection in 29 of 37 initially unresectable cases.
- Higher perioperative complications in the delayed resection group, but no treatment-related mortality.
Conclusions:
- Neoadjuvant chemotherapy is effective in rendering initially unresectable hepatoblastoma amenable to surgical resection.
- Postponing primary resection for chemotherapy is a viable strategy to improve surgical outcomes and reduce risks like exsanguination.