Skip to main content

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

International Journal of Clinical Oncology volume 18, pages 962–968 (2013)Cite this 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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Couinaud C (1954) Lobes et segments hépatiques. Presse Med 62:709 (in French)

    CAS  PubMed  Google Scholar 

  2. Belghiti J, Clavien P-A, Gadzijev E et al (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339

    Google Scholar 

  3. Ortega JA, Douglass EC, Feusner JH et al (2000) Randomized comparison of cisplatin/vincristine/fluorouracil and cisplatin/continuous infusion doxorubicin for treatment of pediatric hepatoblastoma: a report from the Children’s Cancer Group and the Pediatric Oncology Group. J Clin Oncol 18:2665–2675

    CAS  PubMed  Google Scholar 

  4. Meyers RL, Rowland JR, Krailo M et al (2009) Predictive power of pretreatment prognostic factors in children with hepatoblastoma: a report from the Children’s Oncology Group. Pediatr Blood Cancer 53:1016–1022

    PubMed  Article  Google Scholar 

  5. Brown J, Perilongo G, Shafford E et al (2000) Pretreatment prognostic factors for children with hepatoblastoma- results from the International Society of Paediatric Oncology (SIOP) study SIOPEL 1. Eur J Cancer 36:1418–1425

    CAS  PubMed  Article  Google Scholar 

  6. Pritchard J, Brown J, Shafford E et al (2000) Cisplatin, doxorubicin, and delayed surgery for childhood hepatoblastoma: a successful approach–results of the first prospective study of the International Society of Pediatric Oncology. J Clin Oncol 18:3819–3828

    CAS  PubMed  Google Scholar 

  7. Roebuck DJ, Aronson D, Clapuyt P, International Childrhood Liver Tumor Strategy Group et al (2007) 2005 PRETEXT: a revised staging system for primary malignant liver tumours of childhood developed by the SIOPEL group. Pediatr Radiol 37:123–132

    PubMed Central  PubMed  Article  Google Scholar 

  8. Sasaki F, Matsunaga T, Iwafuchi M, Japanese Study Group for Pediatric Liver Tumor et al (2002) Outcome of hepatoblastoma treated with the JPLT-1 (Japanese Study Group for Pediatric Liver Tumor) Protocol-1: a report from the Japanese Study Group for Pediatric Liver Tumor. J Pediatr Surg 37:851–856

    CAS  PubMed  Article  Google Scholar 

  9. Aronson DC, Schnater JM, Staalman CR et al (2005) Predictive value of the pretreatment extent of disease system in hepatoblastoma: results from the International Society of Pediatric Oncology Liver Tumor Study Group SIOPEL-1 study. J Clin Oncol 23:1245–1252

    PubMed  Article  Google Scholar 

  10. Meyers RL, Czauderna P, Otte JB (2012) Surgical treatment of hepatoblastoma. Pediatr Blood Cancer 59:800–808

    PubMed  Article  Google Scholar 

  11. Perilongo G, Shafford E, Maibach R et al (2004) Risk-adapted treatment for childhood hepatoblastoma. final report of the second study of the International Society of Paediatric Oncology—SIOPEL 2. Eur J Cancer 40:411–421

    CAS  PubMed  Article  Google Scholar 

  12. Perilongo G, Maibach R, Shafford E et al (2009) Cisplatin versus cisplatin plus doxorubicin for standard-risk hepatoblastoma. N Engl J Med 361:1662–1670

    CAS  PubMed  Article  Google Scholar 

  13. Hishiki T, Matsunaga T, Sasaki F et al (2011) Outcome of hepatoblastomas treated using the Japanese Study Group for Pediatric Liver Tumor (JPLT) protocol-2: report from the JPLT. Pediatr Surg Int 27:1–8

    PubMed  Article  Google Scholar 

  14. Schnater JM, Aronson DC, Plaschkes J et al (2002) Surgical view of the treatment of patients with hepatoblastoma: results from the first prospective trial of the International Society of Pediatric Oncology Liver Tumor Study Group. Cancer 94:1111–1120

    PubMed  Article  Google Scholar 

  15. Malogolowkin MH, Katzenstein HM, Meyers RL et al (2011) Complete surgical resection is curative for children with hepatoblastoma with pure fetal histology: a report from the Children’s Oncology Group. J Clin Oncol 29:3301–3306

    PubMed Central  PubMed  Article  Google Scholar 

  16. von Schweinitz D, Hecker H, Harms D et al (1995) Complete resection before development of drug resistance is essential for survival from advanced hepatoblastoma—a report from the German Cooperative Pediatric Liver Tumor Study HB-89. J Pediatr Surg 30:845–852

    Article  Google Scholar 

  17. Czauderna P, Otte JB, Aronson DC, Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL) et al (2005) Guidelines for surgical treatment of hepatoblastoma in the modern era–recommendations from the Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL). Eur J Cancer 41:1031–1036

    PubMed  Article  Google Scholar 

  18. Trobaugh-Lotrario AD, Tomlinson GE, Finegold MJ et al (2009) Small cell undifferentiated variant of hepatoblastoma: adverse clinical and molecular features similar to rhabdoid tumors. Pediatr Blood Cancer 52:328–334

    PubMed Central  PubMed  Article  Google Scholar 

  19. Barro C, Wrobleski I, Piolat C et al (2004) Successful use of recombinant factor VIIa for severe surgical liver bleeding in a 5 month-old baby. Hemophilia 10:183–185

    CAS  Article  Google Scholar 

  20. von Schweinitz D (2006) Management of liver tumors in childhood. Semin Pediatr Surg 15:17–24

    Article  Google Scholar 

  21. Czauderna P, Otte JB, Roebuck DJ et al (2006) Surgical treatment of hepatoblastoma in children. Pediatr Radiol 36:187–191

    PubMed  Article  Google Scholar 

  22. Herzog CE, Andrassy RJ, Eftekhari F (2000) Childhood cancers: hepatoblastoma. Oncologist 5:445–453

    CAS  PubMed  Article  Google Scholar 

  23. McCarville MB, Roebuck DJ (2012) Diagnosis and staging of hepatoblastoma: imaging aspects. Pediatr Blood Cancer 59:793–799

    PubMed  Article  Google Scholar 

  24. Aragon RJ, Solomon NL (2012) Techniques of hepatic resection. J Gastrointest Oncol 3:28–40

    PubMed Central  PubMed  Google Scholar 

  25. Pamecha V, Gurusamy KS, Sharma D et al (2009) Techniques for liver parenchymal transection: a meta-analysis of randomized controlled trials. HPB (Oxford) 11:275–281

    Article  Google Scholar 

  26. Otte JB, Pritchard J, Aronson DC, International Society of Pediatric Oncology (SIOP) et al (2004) Liver transplantation for hepatoblastoma: results from the International Society of Pediatric Oncology (SIOP) study SIOPEL-1 and review of the world experience. Pediatr Blood Cancer 42:74–83

    CAS  PubMed  Article  Google Scholar 

  27. Czauderna P, Otte JB, Aronson DC, Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL) et al (2005) Guidelines for surgical treatment of hepatoblastoma in the modern era–recommendations from the Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL). Eur J Cancer 41:1031–1036

    PubMed  Article  Google Scholar 

  28. Meyers RL, Tiao GM, Dunn SP et al (2012) Liver transplantation in the management of unresectable hepatoblastoma in children. Front Biosci (Elite Ed) 4:1293–1302

    Google Scholar 

  29. Stringer MD (2007) The role of liver transplantation in the management of paediatric liver tumours. Ann R Coll Surg Engl 89:12–21

    PubMed Central  PubMed  Article  Google Scholar 

  30. Egawa H, Tanabe K, Fukushima N et al (2012) Current status of organ transplantation in Japan. Am J Transplant 12:523–530

    CAS  PubMed  Article  Google Scholar 

  31. Jin Shu-Guang, Xiang Bo, Yan Lu-Nan et al (2012) Quality of life and psychological outcome of donors after living donor liver transplantation. World J Gastroenterol 18:182–187

    PubMed Central  PubMed  Article  Google Scholar 

  32. Lautz TB, Ben-Ami T, Tantemsapya N et al (2011) Successful nontransplant resection of POST-TEXT III and IV hepatoblastoma. J Am Coll Surg 216:83–89

    Article  Google Scholar 

  33. Tajiri T, Kimura O, Fumino S et al (2012) Surgical strategies for unresectable hepatoblastomas. J Pediatr Surg 47:2194–2198

    PubMed  Article  Google Scholar 

  34. Perilongo G, Brown J, Shafford E et al (2000) Hepatoblastoma presenting with lung metastases: treatment results of the first cooperative, prospective study of the International Society of Paediatric Oncology on childhood liver tumors. Cancer 89:1845–1853

    CAS  PubMed  Article  Google Scholar 

  35. Meyers RL, Katzenstein HM, Krailo M et al (2007) Surgical resection of pulmonary metastatic lesions in children with hepatoblastoma. J Pediatr Surg 42:2050–2056

    PubMed  Article  Google Scholar 

  36. Zsiros J, Brugieres L, Brock P, International Childhood Liver Tumours Strategy Group (SIOPEL) et al (2013) Dose-dense cisplatin-based chemotherapy and surgery for children with high-risk hepatoblastoma (SIOPEL-4): a prospective, single-arm, feasibility study. Lancet Oncol 14:834–842

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  37. Malogolowkin MH, Stanly P, Steele DA et al (2000) Feasibility and toxicity of chemoembolization for children with liver tumors. J Clin Oncol 18:1279–1284

    CAS  PubMed  Google Scholar 

  38. Czauderna P, Zbrzezniak G, Narozanski W et al (2006) Preliminary experience with arterial chemoembolization for hepatoblastoma and hepatocellular carcinoma in children. Pediatr Blood Cancer 46:825–828

    PubMed  Article  Google Scholar 

  39. Ohtsuka Y, Matsunaga T, Yoshida H et al (2004) Optimal strategy of preoperative transcatheter arterial chemoembolization for hepatoblastoma. Surg Today 34:127–133

    PubMed  Article  Google Scholar 

  40. Sakamoto I, Aso N, Nagaoki K et al (1998) Complications associated with transcatheter arterial embolization for hepatic tumors. Radiographics 18:605–619

    CAS  PubMed  Article  Google Scholar 

  41. Yamaura K, Higashi M, Akiyoshi K et al (2000) Pulmonary lipiodol embolism during transcatheter arterial chemoembolization for hepatoblastoma under general anaesthesia. Eur J Anaesth 17:704–708

    CAS  Google Scholar 

Download references

Conflict of interest

The author declares that he has no conflict of interest.

Author information

Affiliations

  1. Department of Pediatric Surgery, Chiba Children’s Hospital, 579-1 Heta-cho, Midori-ku, Chiba, 266-0007, Japan

    Tomoro Hishiki

Authors
  1. Tomoro Hishiki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tomoro Hishiki.

About this article

Cite this article

Hishiki, T. Current therapeutic strategies for childhood hepatic tumors: surgical and interventional treatments for hepatoblastoma. Int J Clin Oncol 18, 962–968 (2013). https://doi.org/10.1007/s10147-013-0625-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-013-0625-7

Keywords

  • Hepatoblastoma
  • Surgery
  • Transplantation
  • Transcatheter arterial chemoembolization