Skip to main content
Log in

Reiterative Radiofrequency Ablation in the Management of Pediatric Patients with Hepatoblastoma Metastases to the Lung, Liver, or Bone

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

HB:

Hepatoblastoma

RFA:

Radiofrequency ablation

References

  1. Darbari A, Sabin KM, Sahpiro CN, et al. Epidemiology of primary hepatic malignancies in U.S. children. Hepatology. 2003;38(3):560–6.

    Article  Google Scholar 

  2. 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.

    Article  CAS  Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. 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.

    Article  CAS  Google Scholar 

  5. 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.

    Article  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. Kremer N, Walther AE, Tiao GM. Management of hepatoblastoma: an update. Curr Opin Pediatr. 2014;26(3):362–9.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  10. 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.

    Article  Google Scholar 

  11. 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.

    PubMed  Google Scholar 

  12. Horton JD, Lee S, Brown SR, et al. Survival trends in children with hepatoblastoma. Pediatr Surg Int. 2009;25(5):407–12.

    Article  Google Scholar 

  13. 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.

    Article  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. 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.

    PubMed  Google Scholar 

  16. Trobaugh-Lotrario AD, Feusner JH. Relapsed hepatoblastoma. Pediatr Blood Cancer. 2012;59:813–7.

    Article  Google Scholar 

  17. 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.

    Article  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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.

    Article  Google Scholar 

  20. 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.

    Article  Google Scholar 

  21. Botsa E, Poulou LS, Koutsogiannis I, et al. CT-guided radiofrequency ablation in children. Pediatr Radiol. 2014;44(11):1421–5.

    Article  Google Scholar 

  22. 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.

    Article  Google Scholar 

  23. 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.

    Article  CAS  Google Scholar 

  24. Hoffer FA. Interventional oncology: the future. Pediatr Radiol. 2011;41:S201–6.

    Article  Google Scholar 

  25. 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.

    Article  Google Scholar 

  26. 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.

    Article  Google Scholar 

  27. Dunn CL, McLean TW, Lucas JT, Clark H. Successful radiofrequency ablation for recurrent pulmonary hepatoblastoma. Pediatr Blood Cancer. 2015;62(12):2242.

    Article  Google Scholar 

  28. 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.

    Article  Google Scholar 

  29. 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.

    Article  Google Scholar 

  30. Ye J, Shu Q, Li M, Jiang TA. Percutaneous radiofrequency ablation for treatment of hepatoblastoma recurrence. Pediatr Radiol. 2008;38:1021–3.

    Article  Google Scholar 

  31. 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.

    Article  Google Scholar 

  32. 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.

    Article  Google Scholar 

  33. 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.

    Article  CAS  Google Scholar 

  34. 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.

    Article  Google Scholar 

  35. 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.

    Article  Google Scholar 

  36. 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.

    Article  Google Scholar 

  37. 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.

    Article  Google Scholar 

  38. 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.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Steven Yevich.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-018-2097-7

Keywords

Navigation