An effective approach for treating unresectable hepatoblastoma in infants and children: Pre‑operative transcatheter arterial chemoembolization

Zhang,Jing; Xu,Fei; Chen,Kunshan; Zhou,Shaoyi; Li,Haibo; Niu,Chuanqiang; Tan,Xiaoyun

doi:10.3892/ol.2013.1444

An effective approach for treating unresectable hepatoblastoma in infants and children: Pre‑operative transcatheter arterial chemoembolization

Authors:
- Jing Zhang
- Fei Xu
- Kunshan Chen
- Shaoyi Zhou
- Haibo Li
- Chuanqiang Niu
- Xiaoyun Tan
View Affiliations

Affiliations: Department of Interventional Radiology and Vacular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou Children's Hospital, Guangzhou, Guangdong 510623, P.R. China, Department of Respiratory Medicine, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi 330006, P.R. China
Published online on: July 3, 2013 https://doi.org/10.3892/ol.2013.1444
Pages: 850-854

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The objective of the present study was to investigate the feasibility and efficacy of pre‑operative transcatheter arterial chemoembolization (TACE) for unresectable hepatoblastoma in infants and children. A total of 24 patients (14 males and 10 females) with unresectable hepatoblastoma, aged between 26 days and 41 months, were treated with pre‑operative TACE between March 2007 and March 2011. All cases were confirmed by computed tomography (CT) and liver tumor biopsy prior to TACE. Arteriography was performed and the chemoembolization mixture (pirarubicin and cisplatin emulsified in lipiodol) was injected, followed by polyvinyl alcohol (PVA). The procedure was performed one to four times depending on the patient's response. There was a significant reduction in tumor volume associated with decreased α-fetoprotein (AFP) levels following TACE. Tumor volumes decreased by between 46.1 and 90.2%, with a mean value of 72%. The AFP levels fell by between 63.8 and 99.9%, with a mean value of 95.7%. A total of 22 cases underwent subsequent safe complete surgical resection and the remaining two patients accepted a partial resection. To evaluate the toxicity of TACE, the alanine aminotransferase (ALT), serum creatinine (Cr) and creatine kinase (CK) levels of the patients were measured to assess liver, renal and cardiac function, respectively. The results showed that no marked chemotherapeutic agent-induced toxicity occurred during TACE. It may be concluded that TACE is an effective and feasible pre‑operative therapeutic approach for treating unresectable hepatoblastoma and that it may improve the resectability of bulky liver tumors.

View Figures

View References

1	Schnater JM, Kohler SE, Lamers WH, et al: Where do we stand with hepatoblastoma? A review. Cancer. 98:668–678. 2003. View Article : Google Scholar : PubMed/NCBI
2	Derek J and Perilongo G: Hepatoblastoma: an oncological review. Pediatr Radiol. 36:183–186. 2006. View Article : Google Scholar : PubMed/NCBI
3	Czauderna P, Otte JB, Roebuck DJ, et al: Surgical treatment of hepatoblastoma in children. Pediatr Radiol. 36:187–191. 2006. View Article : Google Scholar
4	Nakagawa N, Cornelius AS, Kao SCS, et al: Transcatheter oily chemoembolization for unresectable malignant liver tumors in children. J Vasc Intervent Radiol. 4:353–358. 1993. View Article : Google Scholar : PubMed/NCBI
5	Arcement CM, Towbin RB, Meza MP, et al: Intrahepatic chemoembolization in unresectable pediatric liver malignancies. Pediatr Radiol. 30:779–785. 2000. View Article : Google Scholar : PubMed/NCBI
6	Oue T, Fukuzawa M, Kusafuka T, et al: Transcatheter arterial chemoembolization in the treatment of hepatoblastoma. J Pediatr Surg. 33:1771–1775. 1998. View Article : Google Scholar : PubMed/NCBI
7	Tashjian DB, Moriarty KP, Courtney RA, et al: Preoperative chemoembolization for unresectable hepatoblastoma. Pediatr Surg Int. 18:187–189. 2002. View Article : Google Scholar : PubMed/NCBI
8	Exelby PR, Filler RM and Grosfeld JL: Liver tumors in children in the particular reference to hepatoblastoma and hepatocellular carcinoma: American Academy of Pediatrics surgical section survey - 1974. J Pediatr Surg. 10:329–337. 1975. View Article : Google Scholar : PubMed/NCBI
9	Evans AE, Land VJ, Newton WA, et al: Combination chemotherapy (vincristine, adriamycin, cyclophosphamide, and 5-fluorouracil) in the treatment of children with malignant hepatoma. Cancer. 50:821–826. 1982. View Article : Google Scholar : PubMed/NCBI
10	Vogl TJ, Scheller A, Jakob U, et al: Transarterial chemoembolization in the treatment of hepatoblastoma in children. Eur Radiol. 16:1393–1396. 2006. View Article : Google Scholar : PubMed/NCBI
11	Ohtsuka Y, Matsunaga T, Yoshida H, et al: Optimal strategy of preoperative transcatheter arterial chemoembolization for hepatoblastoma. Surg Today. 34:127–133. 2004. View Article : Google Scholar : PubMed/NCBI
12	Li JP, Chu JP, Yang JY, et al: Preoperative transcatheter selective arterial chemoembolization in treatment of unresectable hepatoblastoma in infants and children. Cardiovasc Intervent Radiol. 31:1117–1123. 2008. View Article : Google Scholar : PubMed/NCBI
13	Ortega JA, Krailo MD, Haas JE, et al: Effective treatment of unresectable or metastatic hepatoblastoma with cisplatin and continuous infusion doxorubicin chemotherapy: a report from the Children’s Cancer Study Group. J Clin Oncol. 9:2167–2176. 1991.
14	Seo T, Ando H, Watanabe Y, et al: Treatment of hepatoblastoma: less extensive hepatectomy after effective preoperative chemotherapy with cisplatin and adriamycin. Surgery. 123:407–414. 1998. View Article : Google Scholar : PubMed/NCBI
15	Ehrlich PF, Greenberg ML and Filler RM: Improved long-term survival with preoperative chemotherapy for hepatoblastoma. J Pediatr Surg. 32:999–1003. 1997. View Article : Google Scholar : PubMed/NCBI
16	Ogita S, Tokiwa K, Taniguchi H and Takahashi T: Intraarterial chemotherapy with lipid contrast medium for hepatic malignancies in infants. Cancer. 60:2886–2890. 1987. View Article : Google Scholar : PubMed/NCBI
17	Groupe d’Etude et de Traitement du Carcinome Hépatocellulaire. A comparison of lipiodol chemoembolization and conservative treatment for unresectable hepatocellular carcinoma. N Engl J Med. 332:1256–1261. 1995. View Article : Google Scholar : PubMed/NCBI
18	Llovet JM, Real MI, Montaña X, et al: Arterial embolization or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomized controlled trial. Lancet. 359:1734–1739. 2002. View Article : Google Scholar
19	Iwai K, Maeda H and Konno T: Use of oily contrast medium for selective drug targeting to tumor: enhanced therapeutic effect and X-ray image. Cancer Res. 44:2115–2121. 1984.PubMed/NCBI
20	Nakamura H, Hashimoto T, Oi H and Sawada S: Transcatheter oily chemoembolization of hepatocellular carcinoma. Radiology. 170:783–786. 1989. View Article : Google Scholar : PubMed/NCBI
21	Sasaki Y, Imaoka S, Kasugai H, et al: A new approach to chemoembolization therapy for hepatoma using ethiodized oil, cisplatin, and gelatin sponge. Cancer. 60:1194–1203. 1987. View Article : Google Scholar : PubMed/NCBI
22	Sakamoto I, Aso N, Nagaoki K, et al: Complications associated with transcatheter arterial embolization for hepatic tumors. Radiographics. 18:605–619. 1998. View Article : Google Scholar : PubMed/NCBI
23	Chung JW, Park JH, Im JG, et al: Pulmonary oil embolism after transcatheter oily chemoembolization of hepatocellular carcinoma. Radiology. 187:689–693. 1993. View Article : Google Scholar : PubMed/NCBI