Article

Midterm results with hepatectomy after preoperative chemotherapy in hepatoblastoma

Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
Pediatric Surgery International (Impact Factor: 1.06). 06/2005; 21(5):364-8. DOI: 10.1007/s00383-005-1381-1
Source: PubMed

ABSTRACT We evaluated the results of surgical treatment for hepatoblastoma in infants and children after intensive preoperative chemotherapy, with special reference to histology and extent of liver involvement. The clinical features of 10 children with hepatoblastoma were reviewed regarding response to neoadjuvant chemotherapy, histological subtypes, extent of hepatectomy, operative complications, and prognosis. Response to chemotherapy was measured by volumetric assessment of tumour size by computed tomography scan. Cisplatin and Adriamycin (PLADO regime) up to three cycles markedly reduced the tumour volume on computed tomography (mean regression rate 65.9%); alpha-foetoprotein (AFP) levels also decreased from an initial mean of 16,116.4 ng/ml to 2,050.9 ng/ml. Five patients underwent right hepatectomy, two had right trisegmentectomy, two had left hepatectomy, and one had left trisegmentectomy. Histopathology of resected specimens revealed foetal histology in four patients, poorly differentiated (anaplastic) subtype in three, and mixed histology with mesenchymal components and osteoid formation in three. There was 100% resectability including six unresectable tumours (prechemotherapy). Moreover, hepatic resection tended to be less invasive in patients whose tumours had been much reduced after preoperative chemotherapy. Preoperative administration of cisplatin and Adriamycin reduces the tumour size significantly so that a safe radical hepatectomy can be performed. It also allows early administration of postoperative chemotherapy. Although overall good results were obtained with the current protocol, we also document our experience of unfavourable outcomes in patients with bilobar tumours (despite trisegmentectomy), patients with tumours showing poor response to neoadjuvant chemotherapy, and patients with anaplastic histology. Overall, at a 60-month follow-up we report an 80% survival rate by a combined approach.

1 Follower
 · 
139 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study was designed to retrospectively review our experience with the multimodality management of hepatoblastomas (HB). Thirteen patients were treated for HB between 2000 and 2007. The clinical presentations, chemotherapy tolerance and response, surgical procedure undertaken, and complications were analysed. Median age of the population was 12 months (3-60 months), with a male-to-female ratio of 3.3:1. Nine patients were treated with neoadjuvant chemotherapy incorporating cisplatin and adriamycin. Primary surgery was done in four patients. Extent of hepatic resection in the operated patients varied. Mixed type was the predominant histopathological diagnosis. Adjuvant chemotherapy was well tolerated with no morbidity or mortality. Five-year event-free survival (EFS) and overall survival (OS) of all the 13 patients is 76.9%. All the nine patients who could complete multimodality treatment are alive with no evidence of disease or complications with median follow-up of 63 months (46-122 months). Treatment of HB with multidisciplinary approach was well tolerated. OS and EFS of patients were comparable with published studies.
    Journal of Indian Association of Pediatric Surgeons 03/2011; 16(1):11-4. DOI:10.4103/0971-9261.74514
  • [Show abstract] [Hide abstract]
    ABSTRACT: The cornerstones of successful treatment of hepatoblastoma (HB) include preoperative chemotherapy followed by complete anatomical resection of tumor, followed by chemotherapy. Advances in chemotherapy in the last 2 decades have been associated with a higher rate of tumor response and possibly a greater potential for resectability. We analyzed our single center experience with neoadjuvant chemotherapy (NACT) and surgery in HBs. Our study included all children with HBs who received NACT and underwent surgical excision from January 1997 to July 2004. Patient characteristics, clinical features, clinical course, treatment modalities, and long-term outcome were analyzed. There were 9 boys and 3 girls, aged 5-60 months (median age at tumor diagnosis was 24 months). All received NACT containing cisplatin and doxorubicin. Of the 12 children, 9 underwent hepatectomy and among them, 4 patients each had right and left hepatectomy and 1 patient underwent right extended hepatectomy. After surgery, all patients completed rest of the chemotherapy course (total 6 cycles). R0 resection was carried out in all the 9 cases with no life-threatening complications. Our experience of the 9 cases, although less in number, reaffirms the advantages of NACT followed by surgery. The prognosis for patients with resectable tumors is fairly good in combination with chemotherapy.
    Indian Journal of Cancer 07/2010; 47(3):314-6. DOI:10.4103/0019-509X.64724 · 1.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to assess the effectiveness of high-intensity focused ultrasound (HIFU) combined with transarterial chemoembolization (TACE) in treating pediatric hepatoblastoma. 12 patients with initially unresectable hepatoblastoma were enrolled in the study. All patients received chemotherapy, TACE and HIFU ablation. Follow-up materials were obtained in all patients. The tumor response, survival rate and complication were analyzed. Completely ablation was achieved in 10 patients (83.3%), and the AFP level was also decreased to normal in these patients. The mean follow-up time was 13.3┬▒1.8 months (range, 2-25 months). At the end of follow-up, 2 patients died from tumor progression, the rest 10 patients were alive. One patient was found to have lung metastasis after HIFU and had an operation to remove the lesion. The median survival time was 14 months, and the survival rates of 1, 2-year were 91.7% and 83.3%, respectively. Complication included fever, transient impairment of hepatic function and mild malformation of rib. HIFU combined with TACE is a safe and promising method with a low rate of severe complications. As a non-invasive approach, it may provide a novel locally therapy for patients with unresectable hepatoblastoma. (HEPATOLOGY 2013.).
    Hepatology 01/2014; 59(1). DOI:10.1002/hep.26595 · 11.19 Impact Factor