Abstract
Background and Purpose
Conventional treatments of systemic chemotherapy and surgical resection for recurrent or metastatic hepatoblastoma (HB) may be inhibitive for the pediatric patient and family who have already been through extensive therapies. This single-institution case series evaluates the safety and efficacy of percutaneous radiofrequency ablation (RFA) in the management of metastatic HB.
Materials and Methods
Between March 2008 and February 2015, RFA was used as part of multidisciplinary management for HB recurrence or metastasis in 5 children (median 5.0 years old) in an attempt to provide locoregional control and preclude additional surgery. Combined local treatments of 38 metachronous metastases included surgical metastasectomy (14 lesions: 7 lung, 7 liver), percutaneous RFA (23 lesions: 21 lung, 1 liver, 1 bone), and stereotactic radiotherapy (1 liver lesion).
Results
For lesions treated with RFA (median diameter 6 mm, range 3–15 mm), local control was achieved in 22/23 metastases (95.6%) with median follow-up of 30.1 months after RFA (range 18.9–65.7). Median hospitalization was 3 days (2–7), with major complications limited to 1 pneumothorax requiring temporary small-caliber chest tube. Four children remain in complete remission with median follow-up of 67 months (range 41.2–88.8) after primary tumor resection, with mean disease-free survival of 31.7 months after last local treatment. One child succumbed to rapidly progressive disease 12 months after RFA (23.9 months after primary tumor resection).
Conclusion
RFA provides a safe and effective reiterative treatment option in the multidisciplinary management of children with metastatic HB.
Similar content being viewed by others
Abbreviations
- HB:
-
Hepatoblastoma
- RFA:
-
Radiofrequency ablation
References
Darbari A, Sabin KM, Sahpiro CN, et al. Epidemiology of primary hepatic malignancies in U.S. children. Hepatology. 2003;38(3):560–6.
Mann JR, Kasthuri N, Raafat F, et al. Malignant hepatic tumours in children: incidence, clinical features, and aetiology. Pediatr Perinat Epidemiol. 1990;4(3):276–89.
Browne M, Sher D, Grant D, et al. Survival after liver transplantation for hepatoblastoma: a 2-center experience. J Pediatr Surg. 2008;43(11):1973–81.
Zsiros J, Maibach R, Shafford E, et al. Successful treatment of childhood high-risk hepatoblastoma with dose-intensive multiagent chemotherapy and surgery: final results of the SIOPEL-3HR study. J Clin Oncol. 2010;28(15):2584–90.
Tannuri AC, Cristofani LM, Teixeira RA, et al. New concepts and outcomes for children with hepatoblastoma based on the experience of a tertiary center over the last 21 years. Clinics (Sao Paolo). 2015;70:387–92.
Fuchs J, Rydzynski J, Schweinitz DV, et al. Pretreatment prognostic factors and treatment results in children with hepatoblastoma. A report from the German Cooperative Pediatric Liver Tumor Study HB 94. Cancer. 2002;95(1):172–82.
Ismail H, Broniszczak D, Kalicinski P, et al. Changing treatment and outcome of children with hepatoblastoma: analysis of a single center experience over the last 20 years. J Pediatr Surg. 2012;47(7):1331–9.
Kremer N, Walther AE, Tiao GM. Management of hepatoblastoma: an update. Curr Opin Pediatr. 2014;26(3):362–9.
Semeraro M, Branchereau S, Maibach R, et al. Relapses in hepatoblastoma patients: clinical characteristics and outcome-experience of the international childhood liver tumor strategy group (SIOPEL). Eur J Cancer. 2013;49(4):915–22.
Katzenstein HM, London WB, Douglass EC, et al. Treatment of unresectable and metastatic hepatoblastoma: a paediatric oncology group phase II study. J Clin Oncol. 2002;20:3438–44.
Matsunaga T, Sasaki F, Ohira M, et al. Analysis of treatment outcome for children with recurrent or metastatic hepatoblastoma. Pediatr Surg Int. 2003;19:142–6.
Horton JD, Lee S, Brown SR, et al. Survival trends in children with hepatoblastoma. Pediatr Surg Int. 2009;25(5):407–12.
Meyers RL, Katzenstein HM, Krailo M, et al. Surgical resection of pulmonary metastatic lesions in children with hepatoblastoma. J Pediatr Surg. 2007;42(12):2050–6.
Pham TH, Iqbal CW, Grams JM, et al. Outcomes of primary liver cancer in children: an appraisal of experience. J Pediatr Surg. 2007;42(5):834–9.
Yada K, Ishibashi H, Mori H, et al. The role of surgical treatment in the multidisciplinary therapy for hepatoblastoma. Hepatogastroenterology. 2014;61(131):553–6.
Trobaugh-Lotrario AD, Feusner JH. Relapsed hepatoblastoma. Pediatr Blood Cancer. 2012;59:813–7.
Shi Y, Geller JI, Ma IT, et al. Relapsed hepatoblastoma confined to the lung is effectively treated with pulmonary metastasectomy. J Pediatr Surg. 2016;51(4):525–9.
Carcellar A, Blanchard H, Champagne J, et al. Surgical resection and chemotherapy improve survival rate for patients with hepatoblastoma. J Pediatr Surg. 2001;36:755–9.
Wanaguru D, Shun A, Price N, Karpelowsky J. Outcomes of pulmonary metastases in hepatoblastoma–is the prognosis always poor? J Pediatr Surg. 2013;48(12):2474–8.
de Baere T, Auperin A, Deschamps F, et al. Radiofrequency ablation is a valid treatment option for lung metastases: experience in 566 patients with 1037 metastases. Ann Oncol. 2015;26(5):987–91.
Botsa E, Poulou LS, Koutsogiannis I, et al. CT-guided radiofrequency ablation in children. Pediatr Radiol. 2014;44(11):1421–5.
Gomez FM, Patel PA, Stuart S, Roebuck D. Systematic review of ablation techniques for the treatment of malignant or aggressive benign lesions in children. Pediatr Radiol. 2014;44:1281–9.
Saumet L, Deschamps F, Marec-Berard P, et al. Radiofrequency ablation of metastases from osteosarcoma in patients under 25 years: the SCFE experience. Pediatr Hematol Oncol. 2015;32(1):41–9.
Hoffer FA. Interventional oncology: the future. Pediatr Radiol. 2011;41:S201–6.
Hoffer FA, Daw NC, Xiong X, et al. A phase 1/pilot study of radiofrequency ablation for the treatment of recurrent pediatric solid tumors. Cancer. 2009;115(6):1328–37.
Yevich S, Gaspar N, Tselikas L, et al. Percutaneous computed tomography-guided thermal ablation of pulmonary osteosarcoma metastases in children. Ann Surg Oncol. 2016;23(4):1380–6.
Dunn CL, McLean TW, Lucas JT, Clark H. Successful radiofrequency ablation for recurrent pulmonary hepatoblastoma. Pediatr Blood Cancer. 2015;62(12):2242.
Van Laarhoven S, van Baren R, Tamminga RY, et al. Radiofrequency ablation in the treatment of liver tumors in children. J Pediatr Surg. 2012;47(3):e7–12.
Liu B, Zhou L, Huang G, et al. First experience of ultrasound-guided percutaneous ablation for recurrent hepatoblastoma after liver resection in children. Sci Rep. 2015;18(5):16805.
Ye J, Shu Q, Li M, Jiang TA. Percutaneous radiofrequency ablation for treatment of hepatoblastoma recurrence. Pediatr Radiol. 2008;38:1021–3.
Maibach R, Roebuck D, Brugieres L, et al. Prognostic stratification for children with hepatoblastoma: the SIOPEL experience. Eur J Cancer. 2012;48(10):1543–9.
Czauderna P, Haeberle B, Hiyama E, et al. The children’s hepatic tumors international collaboration (CHIC): novel global rare tumor database yields new prognostic factors in hepatoblastoma and becomes a research model. Eur J Cancer. 2016;52:92–101.
Czauderna P, Lopez-Terrada D, Hiyama E, et al. Hepatoblastoma state of the art: pathology, genetics, risk stratification, and chemotherapy. Curr Opin Pediatr. 2014;26(1):19–28.
Lencioni R, Crocetti L, Cioni R, et al. Response to radiofrequency ablation of pulmonary tumours; a prospective, intention to treat, multicenter clinical trial (the RAPTURE) study. Lancet Oncol. 2008;9(7):621–8.
Cerfolio RJ, McCarthy T, Bryant AS. Non-imaged pulmonary nodules discovered during thoracotomy for metastasectomy by lung palpation. Eur J Cardiothorac Surg. 2009;35(5):786–91.
Kayton ML, Huvos AG, Casher J, et al. Computed tomographic scan of the chest underestimates the number of metastatic lesions in osteosarcoma. J Ped Surg. 2006;41(1):200–6.
Karplus G, McCarville MB, Smeltzer MP, et al. Should contralateral exploratory thoracotomy be advocated for children with osteosarcoma and early unilateral pulmonary metastases? J Pediatr Surg. 2009;44(4):665–71.
de Baere T, Palussiere J, Auperin A, et al. Midterm local efficacy and survival after radiofrequency ablation of lung tumors with minimum follow-up of 1 year: prospective evaluation. Radiology. 2006;240:587–96.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Yevich, S., Calandri, M., Gravel, G. et al. Reiterative Radiofrequency Ablation in the Management of Pediatric Patients with Hepatoblastoma Metastases to the Lung, Liver, or Bone. Cardiovasc Intervent Radiol 42, 41–47 (2019). https://doi.org/10.1007/s00270-018-2097-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-018-2097-7