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Multidisciplinary management of hepatoblastoma in children: Experience from a developing country
Naresh Shanmugam1, Julius Xavier Scott2, Vimal Kumar2
1Department of Pediatric Gastroenterology, Hepatology and Nutrition, Global Health City, Chennai, Tamil Nadu, India.
Insights
Multidisciplinary teams improve outcomes for children with hepatoblastoma (HB), even in resource-limited settings. Expertise in pediatric oncology, liver resection, and transplantation is key for better survival rates in HB patients.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Hepatoblastoma (HB) survival has improved due to advances in chemotherapy, liver resection, and pediatric liver transplantation.
- Optimal management requires a multidisciplinary team (MDT) with access to all treatment modalities.
- Historically, achieving this integrated care model in India presented significant challenges.
Purpose of the Study:
- To evaluate the outcomes of hepatoblastoma treatment in children managed by a specialized MDT in India.
- To assess the feasibility and effectiveness of combined surgical and transplantation approaches for pediatric HB.
Main Methods:
- A review of 30 children under 16 with HB treated between January 2011 and July 2016.
- Data collected prospectively on clinical presentation, neoadjuvant/adjuvant chemotherapy, surgical resection, and liver transplantation.
- Analysis of treatment outcomes, including survival, recurrence, and mortality.
Main Results:
- Nineteen children achieved complete tumor resection, and six underwent living donor liver transplantation.
- Six mortalities occurred, primarily in children with advanced tumors unresponsive to chemotherapy.
- At a median 30-month follow-up, recurrence was observed in three patients (two resection, one transplant).
Conclusions:
- Effective management of pediatric hepatoblastoma is achievable in resource-limited settings through specialized MDTs.
- Expertise in pediatric oncology, liver resection, and transplantation is crucial for improving outcomes in HB patients.
Background:
Advances in chemotherapy, liver resection techniques, and pediatric liver transplantation have vastly improved survival in children with hepatoblastoma (HB). These are best managed by a multidisciplinary team (MDT) in a setting where all treatment options are available. Until recently, this was difficult to achieve in India.
Methods:
All children (<16 years) with HB treated in a pediatric liver surgery and transplantation unit between January 2011 and July 2016 were reviewed. Data regarding the clinical presentation, preoperative management, surgical treatment, postoperative course, and outcomes were extracted from a prospectively managed database.
Results:
Thirty children were treated for HB during the study period. Nine children were PRETEXT 4, 7 were PRETEXT 3, 13 were PRETEXT 2, and 1 was PRETEXT 1 (where PRETEXT is pretreatment extension). All children received a neoadjuvant chemotherapy before surgery followed by an adjuvant chemotherapy. Nineteen children had complete resection, while six underwent primary living donor liver transplantation. There were six mortalities including five children who poorly responded to chemotherapy with progressive tumor extension. At a median follow-up of 30 months, two children who underwent resection and one child who underwent liver transplant had disease recurrence.
Conclusion:
Improved outcomes can be achieved in children with HB even in countries with limited resources when they are managed by MDTs with expertise in pediatric oncology, liver resection, and liver transplantation.
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