Successful liver transplant for unresectable hepatoblastoma.
Publication/Presentation Date
1-1-2007
Abstract
BACKGROUND: Treatment of children with stage III and IV hepatoblastoma has shown little improvement with 5-year survival rates of 64% and 25%, respectively (J Clin Oncol 2000;18:2665-75). A timely and organized treatment program including preoperative chemotherapy combined with living donor liver transplantation and postoperative chemotherapy has been used seeking improved long-term survival in stage III and IV cases.
METHODS: A retrospective review of 8 patients with stage III and IV hepatoblastoma unresectable by conventional resection were treated with complete hepatectomy and transplantation. Approval was obtained from our institutional review board.
RESULTS: Since August of 2001, we have treated 6 patients with stage III hepatoblastoma and 2 patients with initial stage IV hepatoblastoma. These patients (age, 23 months-9 years) had all received extensive chemotherapy or prior resections. After chemotherapy, none had gross tumor documented outside of the liver at time of transplantation. All underwent hepatectomy including vena cava resection, in selected cases, with living donor orthotopic liver transplantation. All patients had at least 2 cycles of postoperative chemotherapy. Of 8 patients, 6 are alive and well with normalized alpha-fetoprotein levels. There were 2 late deaths from recurrent disease. Length of follow-up ranged from 7 to 53 months.
CONCLUSION: Complete hepatectomy with living donor liver transplantation provides optimal surgical treatment in unresectable stage III and initial stage IV disease confined to the liver at resection. This series indicates that children tolerate complete hepatectomy, transplantation, and postoperative chemotherapy well. Referral to a transplant center during the first 3 cycles of chemotherapy appears to offers the best opportunity for long-term survival.
Volume
42
Issue
1
First Page
184
Last Page
187
ISSN
1531-5037
Published In/Presented At
Casas-Melley, A. T., Malatack, J., Consolini, D., Mann, K., Raab, C., Flynn, L., Woolfrey, P., Menendez, J., & Dunn, S. P. (2007). Successful liver transplant for unresectable hepatoblastoma. Journal of pediatric surgery, 42(1), 184–187. https://doi.org/10.1016/j.jpedsurg.2006.09.017
Disciplines
Medicine and Health Sciences | Pediatrics
PubMedID
17208562
Department(s)
Department of Pediatrics
Document Type
Article