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Improved outcome for children with hepatoblastoma
M D Stringer1, S Hennayake, E R Howard
1Department of Paediatric Surgery, King's College Hospital, London, UK.
Insights
This study shows that 90% of hepatoblastoma cases became resectable after chemotherapy, with a 67% survival rate. Selective preoperative chemotherapy significantly improved outcomes for children with liver cancer.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Hepatoblastoma is a rare pediatric liver cancer.
- Treatment strategies have evolved to improve surgical resectability and patient survival.
Purpose of the Study:
- To retrospectively review clinical, radiological, and pathological data of hepatoblastoma cases.
- To evaluate the impact of surgical aspects and selective preoperative chemotherapy on treatment outcomes.
Main Methods:
- Retrospective review of 41 children treated for hepatoblastoma between 1981 and 1993.
- Analysis focused on surgical interventions, chemotherapy regimens (cisplatin and doxorubicin), and patient outcomes.
Main Results:
- 90% of hepatoblastomas were resectable following a selective preoperative chemotherapy approach.
- 22 out of 26 initially unresectable cases became amenable to surgery after chemotherapy.
- 28 survivors were recorded, with 27 disease-free at a median follow-up of 5 years.
- The cumulative survival probability for patients treated with curative intent was 67%.
Conclusions:
- Selective preoperative chemotherapy is a key strategy for improving hepatoblastoma resectability.
- Significant progress in hepatoblastoma treatment has been demonstrated, with favorable outcomes for pure fetal histological subtypes.
Abstract:
Between 1981 and 1993, 41 children were treated for hepatoblastoma. Clinical, radiological and pathological data were reviewed retrospectively, focusing on surgical aspects of treatment and outcome. Fourteen children underwent primary resection of the hepatic tumour. One infant with severe congenital anomalies received only palliative treatment. Of 26 with irresectable disease, pulsed cytotoxic chemotherapy (cisplatin and doxorubicin) enabled subsequent surgical excision in 22 and one child with persistent extensive intrahepatic disease was successfully treated by liver transplantation. Thus, with a policy of selective preoperative chemotherapy, 90 per cent of hepatoblastomas were resectable. There were no perioperative deaths from haemorrhage but one child died from an intraoperative tumour embolus. A total of 28 survivors, 27 of whom are disease-free, were followed for a median of 5 years. The cumulative probability of survival in patients treated with intent to cure was 67 per cent. Analysis of survival data suggested a favourable outcome for those with a pure fetal histological tumour subtype. These results demonstrate significant progress in the treatment of hepatoblastoma.