Salvage Strategies

Abstract

The introduction of cisplatin-based chemotherapy in the 1980s resulted in a dramatic improvement in the survival of children affected by hepatoblastoma (HB). Large (inter)national studies conducted in the last 3 decades have provided solid evidence for the efficacy of neo-adjuvant and/or adjuvant chemotherapy in improving resectability and survival, and pre- and/or postoperative chemotherapy has become an essential part of the treatment strategy for all patients (Ortega et al. 1991, 2000; Perilongo 1999, 2000; Sasaki et al. 2002; Von Schweinitz et al. 1997). The importance of complete surgical resection of all (residual) tumor lesions (after preoperative chemotherapy), as prerequisite for cure, is highly appreciated (Czauderna et al. 2005, 2006; Otte et al. 2004, 2005; Schnater et al. 2002; Von Schweinitz et al. 1987, 1995). The prognosis of patients with localized, resectable disease at diagnosis is very good with administration of limited amount of chemotherapy and tumor resection with partial hepatectomy (Haberle et al. 2003; Ortega et al. 2000; Perilongo et al. 2004, 2009). The use of intensive neo-adjuvant chemotherapy and aggressive surgery (liver transplantation and [multiple] metastectomy, if necessary), leads to a strongly improved survival of patients with locally advanced or metastatic disease (Katzenstein et al. 2002a; Zsíros et al. 2010). Most recent data from the large cooperative studies ­confirm that chemotherapy can be successfully ­stratified according to the presence of initial risk factors giving us the possibility to limit the (long-term) toxicity of chemotherapy in patients with good prognosis (Brown et al. 2000; Fuchs et al. 2002; Malogolowkin et al. 2008; Ortega et al. 2000; Perilongo et al. 2004, 2009).