Novel Use of Bland Trans-Arterial Embolization for Hepatoblastoma: A Case Report

Hepatoblastoma is an embryonal tumor originating from hepatocyte precursors. Surgical resection is the primary treatment. Unresectable cases are treated with chemotherapy combined with liver transplantation. Patients with suboptimal chemotherapy response face limited therapeutic choices. Trans-arterial radioembolization (TARE), trans-arterial chemoembolization (TACE), and bland trans-arterial embolization (TAE) are therapeutic radiologic techniques that preferentially utilize blood supply for liver tumors to deliver microspheres to the tumor. These radiologic techniques used in pediatrics are limited to relapsed diseases or for palliation.

We describe the case of the youngest patient with hepatoblastoma to undergo TARE-Y90 and the first pediatric patient to undergo TAE as a bridge to liver transplantation.

A 12-month-old boy, born prematurely at 25 weeks' gestation, was found to have PRETEXT III, intermediate-risk, non-metastatic, unresectable hepatoblastoma. His initial alpha-fetoprotein (AFP) was elevated to 2,140,000 ng/mL. Systemic chemotherapy had minimal response, and escalation of chemotherapy was unsuccessful, raising concern for chemotherapy resistance. After multidisciplinary discussion, he underwent TARE-Y90 with tumor response by imaging and improved AFP. However, his disease remained unresectable. TAE was performed twice as a bridge to liver transplant, followed by another chemotherapy cycle to minimize metastasis. Both procedures had minimal complications.

This case represents the successful use of TARE and TAE for chemotherapy-resistant hepatoblastoma to reduce tumor burden and to allow for curative liver transplant in a pediatric patient. Short-term outcomes are promising as he underwent cadaveric liver transplantation and continues to do well without evidence of recurrence, 2 years off therapy.