Abstract
Background
Hepatoblastoma is the most common liver malignancy in the pediatric age group. The management of hepatoblastoma involves multidisciplinary approach.
Methods
Patients with hepatoblastoma who underwent liver resection between 2000 and 2013 were analyzed and survival outcomes were studied.
Results
The crude incidence rate of hepatoblastoma at the Madras Metropolitan Tumor Registry (MMTR) is 0.4/1,00,000 population per year. Twelve patients underwent liver resection for hepatoblastoma during the study period; this included eight males and four females. The median age at presentation was 1.75 years (Range 5 months to 3 years). The median serum AFP in the study population was 20,000 ng/ml (Range 4.5 to 1,40,000 ng/ml). Three patients had stage I, one patient had stage II, and eight patients had stage III disease as per the PRETEXT staging system. Two patients were categorized as high risk and ten patients were categorized as standard risk. Seven of these patients received two to four cycles of neoadjuvant chemotherapy (PLADO regimen), and one patient received neoadjuvant radiation up to 84 Gy. Major liver resection was performed in nine patients. Nine patients received adjuvant chemotherapy. The most common histological subtype was embryonal type. Microscopic margin was positive in three cases. One patient recurred 7 months after surgery and the site of failure was the lung. The 5-year overall survival of the case series was 91%. The median survival was 120 months.
Conclusion
Liver resections can be safely performed in pediatric populations after neoadjuvant treatment. Patients undergoing surgery had good disease control and long-term survival.
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References
Malogolowkin MH, Katzenstein HM, Meyers RL, Krailo MD, Rowland JM, Haas J, et al. Complete surgical resection is curative for children with hepatoblastoma with pure fetal histology: a report from the children’s oncology group. J Clin Oncol. 2011;29(24):3301–6.
Misick OS. A case of teratoma hepatis. J Pathol Bacteriol. 1898;5:128–37.
Willis RA. Some uncommon and recently identified tumours. In: Cameron R, Payling Wright G, editors. The pathology of the tumors of children. Charles C. Thoma: Springfield; 1962. p. 57–61.
Daniel C Aronson, MD, PhD, Piotr Czauderna, Rudolf Maibach, Giorgio Perilongo, and Bruce Morland. (2014) The treatment of hepatoblastoma: its evolution and the current status as per the SIOPEL trials. J Indian Assoc Pediatr Surg 19(4): 201–207.
Czauderna P, Otte JB, Aronson DC, Gauthier F, Mackinlay G, Roebuck D, et al. Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL). 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. 2005;41(7):1031–6.
MacKinlay GA, Pritchard J. A common language for childhood liver tumours. Pediatr Surg Int. 1992;7:325–6.
Pritchard J, Brown J, Shafford E, et al. 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. 2000;18:3819–28.
Suita S, Tajiri T, Takamatsu H, Mizote H, Nagasaki A, Inomata Y, et al. Committee for Pediatric Solid Malignant Tumors in the Kyushu area, Japan. Improved survival outcome for hepatoblastoma based on an optimal chemotherapeutic regimen—a report from the study group for pediatric solid malignant tumors in the Kyushu area. J Pediatr Surg. 2004;39(2):195–8. discussion 195-8
Sasaki F, Matsunaga T, Iwafuchi M, Hayashi Y, Ohkawa H, Ohira M, Okamatsu T, Sugito T, Tsuchida Y, Toyosaka A, Nagahara N, Nishihira H, Hata Y, Uchino J, Misugi K, Ohnuma N; (Japanese Study Group for Pediatric Liver Tumor). 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. 2002;37(6):851–6.
Aronson DC, Schnater JM, Staalman CR, Weverling GJ, Plaschkes J, Perilongo G, et al. 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. 2005;23(6):1245–52.
Moon S-B, Shin H-B, Seo J-M, Lee S-K. Hepatoblastoma: 15-year experience and role of surgical treatment. J Korean Surg Soc. 2011;81(2):134–40.
Meyers RL, Rowland JR, Krailo M, Chen Z, Katzenstein HM, Malogolowkin MH. Predictive power of pretreatment prognostic factors in children with hepatoblastoma: a report from the Children’s Oncology Group. Pediatr Blood Cancer. 2009;53(6):1016–22.
Benoist S, Nordlinger B. The role of preoperative chemotherapy in patients with resectable colorectal liver metastases. Ann Surg Oncol. 2009;16(9):2385–90.
Richard M, Conran CL, Hitchcock MA, Waclawiw J, Stocker T, Ishak KG. Hepatoblastoma: the prognostic significance of histologic type. Paediatric Pathology. 1992;12(2)
Davies JQ, de la Hall PM, Kaschula RO, Sinclair-Smith CC, Hartley P, Rode H, et al. Hepatoblastoma—evolution of management and outcome and significance of histology of the resected tumor. A 31-year experience with 40 cases. J Pediatr Surg. 2004;39(9):1321–7.
Shi Y, Commander SJ, Masand PM, Heczey A, Goss JA, Vasudevan SA. Vascular invasion is a prognostic indicator in hepatoblastoma. J Pediatr Surg. 2017; https://doi.org/10.1016/j.jpedsurg.2017.03.017.
Schnater JM, Aronson DC, Plaschkes J, Perilongo G, Brown J, Otte JB, et al. 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. 2002;94(4):1111–20.
Fuchs J, Rydzynski J, Hecker H, Mildenberger H, Bürger D, Harms D, V Schweinitz D; (2002) German Cooperative Liver Tumour Studies HB 89 and HB 94. The influence of preoperative chemotherapy and surgical technique in the treatment of hepatoblastoma—a report from the German Cooperative Liver Tumour Studies HB 89 and HB 94. Eur J Pediatr Surg 12(4):255–261.
Ang JP, Heath JA, Donath S, Khurana S, Auldist A. Treatment outcomes for hepatoblastoma: an institution’s experience over two decades. Pediatr Surg Int. 2007;23(2):103–9. Epub 2006 Nov 21
Shanmugam N, Scott JX, Kumar V, Vij M, Ramachandran P, Narasimhan G, et al. Multidisciplinary management of hepatoblastoma in children: experience from a developing country. Pediatr Blood Cancer. 2017;64(3) https://doi.org/10.1002/pbc.26249.
Yada K, Ishibashi H, Mori H, Sato H, Shimada M. The role of surgical treatment in the multidisciplinary therapy for hepatoblastoma. Hepato-Gastroenterology. 2014;61(131):553–6.
Malek MM, Shah SR, Atri P, Paredes JL, DiCicco LA, Sindhi R, et al. Review of outcomes of primary liver cancers in children: our institutional experience with resection and transplantation. Surgery. 2010;148(4):778–782; discussion 782-4. https://doi.org/10.1016/j.surg.2010.07.021.
Hou JY, Liu HC, Yeh TC, Chen SH, Wang LY, Sheu JC, et al. Long-term treatment results of hepatoblastoma at a single institution in Taiwan. J Pediatr Hematol Oncol. 2009;31(10):718–22. https://doi.org/10.1097/MPH.0b013e3181b6db88.
Towu E, Kiely E, Pierro A, Spitz L. Outcome and complications after resection of hepatoblastoma. J Pediatr Surg. 2004;39:199–202. discussion 199-202
Teran DA, Beltran OG, Bru RC, González EM, Rosa MJP, Molina AL, et al. Efficacy of neoadjuvant therapy and surgical rescue for locally advanced hepatoblastomas: 10 year single-center experience and literature review. World J Gastroenterol. 2014;20(29):10137–43.
Tannuri ACA, Cristofani LM, Teixeira RAP, Filho VO, Tannuri U. New concepts and outcomes for children with hepatoblastoma based on the experience of a tertiary center over the last 21 years. Clinics (Sao Paulo). 2015;70(6):387–92.
Tsay P-K, Lai J-Y, Yang C-P, Hung I-J, Hsueh C, Tsai M-H, et al. Treatment outcomes for hepatoblastoma: experience of 35 cases at a single institution. J Formos Med Assoc. 2011;110(5):322–5.
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Bhanu Jayanand Sunil: Conception and design of work/acquisition, analysis, and interpretation of data; drafting the work and revising; final approval of the version; agreement for all aspects of the work.
Ravisankar Palaniappan: Conception and design of work/acquisition, analysis, and interpretation of data; drafting the work and revising; final approval of the version; agreement for all aspects of the work.
Balasubramanian Venkitaraman: Conception and design of work/acquisition, analysis, and interpretation of data; drafting the work and revising; final approval of the version; agreement for all aspects of the work.
Rama Ranganathan: Analysis, and interpretation of data; drafting the work and revising; final approval of the version; agreement for all aspects of the work.
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Scientific Meeting: 28th Meeting of Japanese Society of Hepato-Biliary-Pancreatic Surgery in Osaka, Japan. 2–4 June 2017.
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Sunil, B.J., Palaniappan, R., Venkitaraman, B. et al. Surgical Resection for Hepatoblastoma—Updated Survival Outcomes. J Gastrointest Canc 49, 493–496 (2018). https://doi.org/10.1007/s12029-017-0005-z
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DOI: https://doi.org/10.1007/s12029-017-0005-z