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Treatment of infantile hepatoblastoma and related complications
Shigeru Ueno1, Hitoshi Hirakawa, Seishichi Yokoyama
1Department of Pediatric Surgery, Gastrointestinal Surgery and Radiology, Tokai University School of Medicine, Kanagawa, Japan. urantets@is.icc.u-tokai.ac.jp
Insights
This study details a successful treatment protocol for hepatoblastoma in infants, involving chemotherapy and interventions. Controlling treatment side effects is crucial for successful outcomes in young children with this rare liver cancer.
Area of Science:
- Pediatric Oncology
- Hepatobiliary Malignancies
Background:
- Hepatoblastoma is a rare childhood liver cancer with improving prognoses.
- Infantile hepatoblastoma treatment failures are often linked to treatment-related deaths.
Observation:
- A treatment protocol involving preoperative chemotherapy (cisplatin and THP-ADR) with age-adjusted doses, radiological interventions, and tumor resection was used.
- Four infants, including cases with spontaneous rupture and recurrence, were successfully treated.
Findings:
- Trans-arterial embolization effectively managed bleeding from rupture and reduced intraoperative blood loss.
- Despite dose modifications, significant hematological side effects occurred, and cisplatin-induced hearing loss persisted in one patient.
Implications:
- Strategic surgical and radiological interventions are vital for treating hepatoblastoma in young infants.
- Careful management of treatment-related side effects is essential for successful hepatoblastoma treatment in infants.
Abstract:
Hepatorblastoma is an uncommon childhood malignant tumor of hepatic origin and recent progress of treatment strategy resulted in improved prognosis of patients with hepatoblastoma. Although patients within one year of age were considered to have better prognosis than those over that age, the treatment related deaths have been reported to be the only cause of the treatment failure of the infantile hepatoblastoma. We have successfully treated 4 infants including one with spontaneous rupture and the other with recurrence. Treatment protocol was preoperative chemotherapy using cisplatin and THP-ADR, doses of which were modified according to the age, with optional radiological interventions followed by resection of the primary tumor. This report would describe their clinical courses and experienced side effects of the treatment in order to demonstrate its risk. Trans-arterial embolizations were beneficial to stop bleeding due to rupture and to reduce intraoperative blood loss. In spite of dose modifications high hematological side effects were inevitable and cisplatn-induced hearing loss persisted in one case. In conclusion, for small infants with hepatoblastoma, controlling the inevitable side effects and active but strategic surgical and radiological interventions are essential for successful treatment.