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International Journal of Clinical Oncology

, Volume 18, Issue 6, pp 962–968 | Cite as

Current therapeutic strategies for childhood hepatic tumors: surgical and interventional treatments for hepatoblastoma

  • Tomoro HishikiEmail author
Review Article

Abstract

Surgery is the mainstay of multimodal treatment for hepatoblastomas. Among the various staging systems used, PRETEXT is currently adopted in all major study groups worldwide as a common pretreatment staging system. Although variations of treatment strategies among study groups exist, the majority of hepatoblastoma cases currently undergo preoperative chemotherapy. It is therefore critical to determine the optimal surgical treatment during the initial courses of chemotherapy. Patients with PRETEXT IV tumors, multifocal tumors and tumors invading major vessels of the liver are candidates for liver transplantation. Liver transplantation requires preparation in advance, and consultation to a liver expertise team must take place no later than after two cycles of chemotherapy. The existence of pulmonary metastasis is a predictor of poor prognosis of the patient. Surgery for pulmonary nodules should be considered for those patients remaining positive after cycles of chemotherapy. A considerable number of patients have been reported to achieve long-term survival after resecting pulmonary metastasis. The existence of pulmonary metastasis at diagnosis is no longer a contraindication for liver transplantation, provided that the pulmonary nodules are eliminated by chemotherapy or by metastasectomy. Transcatheter arterial chemoembolization (TACE) is a useful tool for the local control of hepatoblastomas, although there are very few reports statistically supporting the significant advantage of this treatment modality. Based on individual cases, TACE could be beneficial in maximizing the anti-tumor effect with less toxic side effects.

Keywords

Hepatoblastoma Surgery Transplantation Transcatheter arterial chemoembolization 

Notes

Conflict of interest

The author declares that he has no conflict of interest.

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Copyright information

© Japan Society of Clinical Oncology 2013

Authors and Affiliations

  1. 1.Department of Pediatric SurgeryChiba Children’s HospitalMidori-ku, ChibaJapan

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