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Kim BK, Choi JY, Hong KT, Park HJ, Kang HJ. Successful Treatment of Refractory or Relapsed Hepatoblastoma With Autologous Hematopoietic Stem Cell Transplantation in Children. J Pediatr Hematol Oncol 2024:00043426-990000000-00426. [PMID: 38830616 DOI: 10.1097/mph.0000000000002888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 04/17/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND The standard-risk hepatoblastoma has a good prognosis in children; however, refractory or relapsed (R/R) hepatoblastoma has a poor prognosis and high mortality rate. This study aimed to demonstrate the efficacy of high-dose chemotherapy and autologous hematopoietic stem cell transplantation (HSCT) rescue in pediatric patients with R/R hepatoblastoma. METHODS We retrospectively analyzed 6 pediatric patients with R/R hepatoblastoma who underwent autologous HSCT. The MEC conditioning regimen was used for all patients, comprising melphalan 140 mg/m2/day intravenously (IV) on day 7 and 70 mg/m2 on day 6, etoposide 200 mg/m2 IV on days 5 to 8, and carboplatin 400 mg/m2 IV on days 5 to 8. One patient received a TopoThioCarbo regimen, comprising topotecan 2 mg/m2/day IV on days 4 to 8, thiotepa 300 mg/m2/day IV on days 6 to 8, and carboplatin 500 mg/m2/day IV on days 3 to 5, as the conditioning regimen for the first transplantation. This was followed by salvage chemotherapy for relapse, and the second transplantation was performed using MEC as the conditioning regimen. RESULTS We report the retrospective results of 6 patients with a median age of 1.8 (range 0.4 to 10.2) years who had R/R hepatoblastoma and underwent autologous HSCT. The median follow-up period was 58 (range 28 to 113) months after diagnosis. The median stage at diagnosis was 2.0 (range 2 to 4). Two patients had lung metastases during diagnosis. The median initial alpha-fetoprotein level was 292,888 (range 28,831 to 2,406,942) ng/mL, and the median number of chemotherapy lines before autologous HSCT was 3.5 (range 2 to 7). The disease status before HSCT was complete remission (CR) for all patients. The engraftment rate was 100%. No treatment-related mortality was reported. The 3-year event-free survival and overall survival rates were 83.3% and 100%, respectively. One patient relapsed after the second HSCT and achieved CR after salvage chemotherapy. CONCLUSION This study suggests autologous HSCT as an effective treatment in pediatric patients with R/R hepatoblastoma. Nevertheless, future large-scale prospective studies are warranted.
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Affiliation(s)
- Bo Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine
- Seoul National University Cancer Research Institute, Seoul, Korea
| | - Jung Yoon Choi
- Department of Pediatrics, Seoul National University College of Medicine
- Seoul National University Cancer Research Institute, Seoul, Korea
| | - Kyung Taek Hong
- Department of Pediatrics, Seoul National University College of Medicine
- Seoul National University Cancer Research Institute, Seoul, Korea
| | - Hyun Jin Park
- Department of Pediatrics, Seoul National University College of Medicine
- Seoul National University Cancer Research Institute, Seoul, Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine
- Seoul National University Cancer Research Institute, Seoul, Korea
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Davini M, Hastings C, Feusner J. The Utility of Serum Alpha-fetoprotein for Monitoring for Relapse of Alpha-fetoprotein-Positive Hepatoblastoma. J Pediatr Hematol Oncol 2024; 46:206-210. [PMID: 38551915 DOI: 10.1097/mph.0000000000002832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/19/2024] [Indexed: 04/24/2024]
Abstract
Hepatoblastoma is the most common liver malignancy in children. Treatment typically involves surgery and cisplatin-based chemotherapy. After therapy completion, children undergo repetitive surveillance imaging to screen for relapse, which occurs in <12% of cases. Monitoring for relapse has gradually shifted to serial determination of serum alpha-fetoprotein (AFP) alone as most cases have AFP elevation at the time of relapse. Little primary data supports, such a practice, however, and herein we present both our institutional experience with relapsed hepatoblastoma and a careful review of published literature on this topic. While serial AFP monitoring may suffice for most patients, certain clinical characteristics should give pause to the practitioner, when considering posttreatment monitoring with serum AFP alone.
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Affiliation(s)
- Monica Davini
- Department of Pediatric Hematology and Oncology, Banner University Medical Center, University of Arizona Cancer Center
| | - Caroline Hastings
- Department of Pediatric Hematology and Oncology, UCSF Benioff Children's Hospital Oakland (Children Hospital and Research Center Oakland), Oakland, CA
| | - James Feusner
- Department of Pediatric Hematology and Oncology, UCSF Benioff Children's Hospital Oakland (Children Hospital and Research Center Oakland), Oakland, CA
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O’Neill AF, Trobaugh-Lotrario A, Geller JI, Hiyama E, Watanabe K, Aerts I, Fresneau B, Toutain F, Sullivan MJ, Katzenstein HM, Morland B, Branchereau S, Zsiros J, Maibach R, Ansari M. The RELIVE consortium for relapsed or refractory pediatric hepatoblastoma and hepatocellular carcinoma: a scoping review of the problem and a proposed solution. EClinicalMedicine 2024; 69:102446. [PMID: 38384339 PMCID: PMC10879668 DOI: 10.1016/j.eclinm.2024.102446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/21/2023] [Accepted: 01/12/2024] [Indexed: 02/23/2024] Open
Abstract
Liver tumors account for approximately 2% of all pediatric malignancies. Children with advanced stages of hepatoblastoma (HB) are cured only 50-70% of the time while children with advanced hepatocellular carcinoma (HCC) have a <20% 5-year overall survival. This scoping review was performed to highlight the paucity of rigorous, reliable data guiding the management of relapsed pediatric HB or HCC. When these patients are enrolled on prospective trials, the trials are often histology-agnostic, exclude patients less than a year of age, lack a liquid formulary of the drug under study, exclude recipients of a solid organ transplant, and enroll only 1-2 patients limiting the ability to deduce efficacious regimens for current use or future study. We highlight the creation of a global pediatric consortium intended to source retrospective relapse data from over 100 institutions spanning 4 continents. The data collected from this effort will inform future relapse trials.
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Affiliation(s)
- Allison F. O’Neill
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | | | - James I. Geller
- Division of Oncology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Eiso Hiyama
- Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Isabelle Aerts
- Institut Curie, PSL Research University, Oncology Center SIREDO, Paris, France
| | - Brice Fresneau
- Department of Children and Adolescent Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Fabienne Toutain
- Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva-Department of Women, Child, and Adolescent, Onco-hematology Unit and Cansearch Research Platform for Pediatric Oncology and Hematology, University of Geneva, Geneva, Switzerland
| | | | | | - Bruce Morland
- Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | | | - József Zsiros
- Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Marc Ansari
- Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva-Department of Women, Child, and Adolescent, Onco-hematology Unit and Cansearch Research Platform for Pediatric Oncology and Hematology, University of Geneva, Geneva, Switzerland
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4
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Trobaugh-Lotrario A, Katzenstein HM, Ranganathan S, Lopez-Terrada D, Krailo MD, Piao J, Chung N, Randazzo J, Malogolowkin MH, Furman WL, McCarville EB, Towbin AJ, Tiao GM, Dunn SP, Langham MR, McGahren ED, Feusner J, Rodriguez-Galindo C, Meyers RL, O'Neill AF, Finegold MJ. Small Cell Undifferentiated Histology Does Not Adversely Affect Outcome in Hepatoblastoma: A Report From the Children's Oncology Group (COG) AHEP0731 Study Committee. J Clin Oncol 2022; 40:459-467. [PMID: 34874751 PMCID: PMC8824398 DOI: 10.1200/jco.21.00803] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/09/2021] [Accepted: 11/01/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Small cell undifferentiated (SCU) histology in hepatoblastoma (HB) tumors has historically been associated with a poor prognosis. Tumors from patients enrolled on Children's Oncology Group (COG) study AHEP0731 underwent institutional and central pathologic review for identification of SCU histology. PATIENTS AND METHODS Patients with SCU histology identified at the local treating institution who had otherwise low-risk tumors were upstaged to the intermediate-risk treatment stratum, whereas those only identified by retrospective central review were treated per the local institution as low-risk. Patients with otherwise intermediate- or high-risk tumors remained in that treatment stratum, respectively. Central review was to be performed for all tissue samples obtained at any time point. Treatment was per local review, whereas analysis of outcome was based on central review. RESULTS Thirty-five patients had some elements (1%-25%) of SCU identified on central review of diagnostic specimens. All but two patient tissue sample retained nuclear INI1 expression. The presence of SCU histology did not correlate with age, alpha-fetoprotein level at diagnosis, or sex. The presence of SCU did not affect event-free survival (EFS). EFS at 5 years for patients with low-risk, intermediate-risk, and high-risk with SCU HB was 86% (95% CI, 33 to 98), 81% (95% CI, 57 to 92), and 29% (95% CI, 4 to 61), respectively, compared with EFS at 5 years for patients without SCU enrolled with low-risk, intermediate-risk, and high-risk of 87% (95% CI, 72 to 95), 88% (95% CI, 79 to 94), and 55% (95% CI, 32 to 74; P = .17), respectively. CONCLUSION The presence of SCU histology in HB does not appear to adversely affect outcome. Future studies should be able to treat patients with SCU HB according to risk stratification without regard to the presence of SCU histology.
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Affiliation(s)
| | | | | | | | - Mark D. Krailo
- University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Jin Piao
- Children's Oncology Group, Monrovia, CA
| | | | | | | | - Wayne L. Furman
- University of Tennessee Health Science Center and St Jude Children's Research Hospital, Memphis, TN
| | - Elizabeth B. McCarville
- University of Tennessee Health Science Center and St Jude Children's Research Hospital, Memphis, TN
| | | | - Greg M. Tiao
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stephen P. Dunn
- AI duPont Hospital for Children and Thomas Jefferson University, Philadelphia, PA
| | - Max R. Langham
- University of Tennessee Health Science Center and St Jude Children's Research Hospital, Memphis, TN
| | - Eugene D. McGahren
- University of Virginia Children's Hospital and University of Virginia, Charlottesville, VA
| | | | - Carlos Rodriguez-Galindo
- University of Tennessee Health Science Center and St Jude Children's Research Hospital, Memphis, TN
| | | | - Allison F. O'Neill
- Dana-Farber Cancer Institute, and Boston Children's Hospital, Boston, MA
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Agarwala S, Gupta A, Bansal D, Vora T, Prasad M, Arora B, Kapoor G, Chinnaswamy G, Radhakrishnan V, Laskar S, Kaur T, Dhaliwal RS, Rath GK, Bakhshi S. Management of Hepatoblastoma: ICMR Consensus Document. Indian J Pediatr 2017; 84:456-464. [PMID: 28353129 DOI: 10.1007/s12098-017-2301-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 01/25/2017] [Indexed: 10/19/2022]
Abstract
Dramatic advancement has been made in the management of children with hepatoblastoma (HB) over the past 3 decades owing to the improvement in diagnostic imaging, new chemotherapeutic agents, better surgical care and availability of liver transplantation. These advances are the end results of contributions from 4 major study groups across the globe including International Society of Pediatric Oncology - Liver Tumor Strategy Group (SIOPEL), Children's Oncology Group (COG), German Pediatric Hematology Oncology Group (GPOH) and Japanese Pediatric Liver Tumor Study Group (JPLT). The current manuscript is written with the objective of developing a consensus guideline for practitioners at a National level. Based on literature and personal experience over last 3 decades, the Indian Council of Medical Research (ICMR) Expert group has made recommendations for management of children with HB in resource-challenged nations including India.
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Affiliation(s)
- Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Alisha Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Deepak Bansal
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tushar Vora
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Maya Prasad
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Brijesh Arora
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Gauri Kapoor
- Department of Pediatric Hematology & Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Venkatraman Radhakrishnan
- Department of Medical Oncology and Pediatric Oncology, Cancer Institute (W.I.A), Adyar, Chennai, India
| | - Siddharth Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Tanvir Kaur
- NCD Division, Indian Council of Medical Research (ICMR), New Delhi, India
| | | | - G K Rath
- Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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6
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Katzenstein HM, Furman WL, Malogolowkin MH, Krailo MD, McCarville MB, Towbin AJ, Tiao GM, Finegold MJ, Ranganathan S, Dunn SP, Langham MR, McGahren ED, Rodriguez-Galindo C, Meyers RL. Upfront window vincristine/irinotecan treatment of high-risk hepatoblastoma: A report from the Children's Oncology Group AHEP0731 study committee. Cancer 2017; 123:2360-2367. [PMID: 28211941 DOI: 10.1002/cncr.30591] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 12/15/2016] [Accepted: 01/03/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The identification of new therapies for high-risk (HR) hepatoblastoma is challenging. Children's Oncology Group study AHEP0731 included a HR stratum to explore the efficacy of novel agents. Herein, the authors report the response rate to the combination of vincristine (V) and irinotecan (I) and the outcome of patients with high-risk hepatoblastoma. METHODS Patients with newly diagnosed metastatic hepatoblastoma or those with a serum α-fetoprotein (AFP) level <100 ng/mL were eligible. Patients received 2 cycles of V at a dose of 1.5 mg/m2 /day intravenously on days 1 and 8 and I at a dose of 50 mg/m2 /day intravenously on days 1 to 5. Patients were defined as responders if they had either a 30% decrease in tumor burden according to Response Evaluation Criteria In Solid Tumors (RECIST) or a 90% (>1 log10 ) decline in their AFP level. Responders were to receive 2 additional cycles of VI intermixed with 6 cycles of the combination of cisplatin, doxorubicin, 5-fluorouracil, and vincristine (C5VD). Nonresponders were to receive 6 cycles of C5VD alone. RESULTS A total of 32 patients with a median age at diagnosis of 26 months (range, 11-159 months) were enrolled between September 2009 and February 2012. Fourteen of 30 evaluable patients were responders (RECIST and AFP in 6 patients, RECIST only in 3 patients, and AFP only in 5 patients). The median AFP decline after 2 cycles of VI for the entire group was 345,565 ng/mL (85% of the initial AFP). The 3-year event-free and overall survival rates were 49% (95% confidence interval, 30%-65%) and 62% (95% confidence interval, 42%-77%), respectively. CONCLUSIONS The VI combination appears to have substantial activity against HR hepatoblastoma. The ultimate impact of this regimen in improving the outcomes of children with HR hepatoblastoma remains to be determined. Cancer 2017;123:2360-2367. © 2017 American Cancer Society.
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Affiliation(s)
- Howard M Katzenstein
- Division of Pediatric Hematology/Oncology, Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, Tennessee
| | - Wayne L Furman
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Marcio H Malogolowkin
- Division of Pediatric Hematology/Oncology, University of California at Davis Comprehensive Cancer Center, Sacramento, California
| | - Mark D Krailo
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - M Beth McCarville
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Alexander J Towbin
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Greg M Tiao
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Sarangarajan Ranganathan
- Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stephen P Dunn
- Department of Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Max R Langham
- Division of Pediatric Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Eugene D McGahren
- Division of Pediatric Surgery, University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Rebecka L Meyers
- Department of Pediatric Surgery, Primary Children's Medical Center, Salt Lake City, Utah
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7
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Zhang YT, Feng LH, Zhong XD, Wang LZ, Chang J. Vincristine and irinotecan in children with relapsed hepatoblastoma: a single-institution experience. Pediatr Hematol Oncol 2015; 32:18-25. [PMID: 24852330 DOI: 10.3109/08880018.2014.909913] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE This study was to determine the efficacy of vincristine and irinotecan in children with relapsed hepatoblastoma (HB). METHODS A total of 10 patients with relapsed HB were enrolled. Three patients were excluded. Patients received irinotecan 50 mg/m(2)/day, day 1-5 and vincristine 1.5 mg/m(2)/day, day 1, repeated every 3 weeks. The maximum cycles were eight. Reevaluation of tumor was performed every two cycles. The primary outcome was the rate of complete resection. Secondary outcomes were event-free survival (EFS) and overall survival (OS). RESULTS Of the seven patients assessable for response, one patient with normal AFP level showed a progressive disease and withdrew. He finally died 6 months later. Four had PR, all of them underwent a second surgery and achieved complete resection. Two patients had SD, one patient relapsed 6 months after orthotopic liver transplantation and died, the other one undergoing surgery had micro margin positive, he relapsed again but alive. The rate of complete resection was 71.4% (including orthotopic liver transplantation). The 2-year EFS and OS for the whole group were 57.1% (95% CI, 12.7% to 34.2%) and 71.4% (95% CI, 16.39% to 37.4%), respectively. CONCLUSIONS The combination of irinotecan and vincristine has a significant antitumor activity and acceptable toxicity in children with relapsed HB.
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Affiliation(s)
- Yu-tong Zhang
- 1Department of Pediatric Hematology and Oncology, the First Hospital of Jilin University, Changchun, Jilin, China
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Abstract
Hepatoblastoma (HBL) is the most common primary liver tumor in children, and is usually diagnosed during the first 3 years of life. Collaborative multicenter studies have led to improved diagnostic and treatment strategies. The pretreatment extent of disease (PRETEXT) staging system has become a consensus classification, and an international pathological classification system has also been developed. Clinical trials examining multimodal therapy, which consists of complete surgical resection plus liver transplantation and chemotherapy, have led to improved outcomes for children with HBL. Recently, the Children's Hepatic Tumors International Collaboration (CHIC), which includes major multicenter study groups, created a shared database that merges data on all children underwent therapy in the clinical trials of these groups until 2008. CHIC has developed a global approach to risk stratification of pediatric HBL for use in future global clinical trials. The aim of this review is to report the recent developments on the diagnosis and treatment of pediatric HBL.
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Affiliation(s)
- Eiso Hiyama
- Department of Pediatric Surgery, Hiroshima University Hospital; and the Natural Science Center for Basic Research and Development (N-BARD), Hiroshima University, Hiroshima, Japan
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9
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Provenzi M, Saettini F, Conter V, Giraldi E, Foglia C, Cavalleri L, Colledan M, D'Antiga L, Perilongo G, Da Dalt L. Is there a role for high dose chemotherapy and blood stem cell rescue in childhood hepatoblastoma presenting with lung metastases? A case report and literature review. Ital J Pediatr 2013; 39:65. [PMID: 24148885 PMCID: PMC4016556 DOI: 10.1186/1824-7288-39-65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/18/2013] [Indexed: 11/15/2022] Open
Abstract
We report the use of high dose chemotherapy with peripheral blood stem cell rescue as a consolidation treatment for a 3-year-old child affected by metastatic hepatoblastoma, who achieved complete lung response only after conventional treatment. The patient is presently alive 27 months after high dose chemotherapy with blood stem cell rescue with no evidence of disease. The role of high dose chemotherapy with blood stem cell rescue to consolidate the complete clearing of lung disease in metastatic hepatoblastoma remains controversial; the data available in the literature and our experience seems to suggest to keep this treatment option open to further consideration in the clinical setting of high-risk patients.
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Affiliation(s)
| | - Francesco Saettini
- Department of Pediatrics, University of Milano-Bicocca, San Gerardo Hospital, Via Pergolesi 33, Monza, 20900, Italy.
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10
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Hiyama E. Current therapeutic strategies for childhood hepatic malignant tumors. Int J Clin Oncol 2013; 18:943-5. [PMID: 24057320 DOI: 10.1007/s10147-013-0607-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Indexed: 10/26/2022]
Abstract
The two main malignant hepatic tumors in children are hepatoblastomas (HBLs) and hepatocellular carcinomas (HCCs). The past two decades have brought significant improvement to the outcomes of children diagnosed with malignant hepatic tumors, especially HBL, due to improvements in diagnosis and treatment. Histological diagnosis is essential for differential diagnosis of these tumors. In surgery, liver resection has become a safe and secure technique because of progress in anatomical knowledge and surgical dissection; also liver transplantation has become widely used for unresectable tumors. Moreover, the introduction of effective chemotherapeutic regimens has significantly improved the survival of children with HBL due to an increase in the number of patients ultimately undergoing tumor resection, and a reduction in the incidence of post-surgical recurrence. These improvements are the result of multicenter cooperative trials conducted by the Japanese Study Group for Pediatric Liver Tumor, the Children's Oncology Group, and the International Childhood Liver Tumor Strategy Group, including work of the German Association of Pediatric Hematology and Oncology. This paper summarizes the results of these studies and calls on the current international collaboration study called the Children's Hepatic Tumors International Collaboration Project to establish global clinical research on childhood hepatic malignant tumors.
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Affiliation(s)
- Eiso Hiyama
- Department of Pediatric Surgery, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan,
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Zsíros J, Brugières L, Brock P, Roebuck D, Maibach R, Child M, Morland B, Casanova M, Pariente D, Paris C, Camargo BD, Ronghe M, Zimmermann A, Plaschkes J, Czauderna P, Perilongo G. Efficacy of irinotecan single drug treatment in children with refractory or recurrent hepatoblastoma – A phase II trial of the childhood liver tumour strategy group (SIOPEL). Eur J Cancer 2012; 48:3456-64. [DOI: 10.1016/j.ejca.2012.06.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/18/2012] [Accepted: 06/28/2012] [Indexed: 10/28/2022]
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12
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Trobaugh-Lotrario AD, Feusner JH. Relapsed hepatoblastoma. Pediatr Blood Cancer 2012; 59:813-7. [PMID: 22648963 DOI: 10.1002/pbc.24218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/08/2012] [Indexed: 12/11/2022]
Abstract
Successful treatment of recurrent hepatoblastoma (HB) relies largely on surgical resection. When tumors are responsive, chemotherapy can be used to render patients resectable. Various chemotherapeutic regimens studied in small numbers of patients on phase I/II trials have shown few responses. The best available data indicate that doxorubicin, if not given during intial treatment, and irinotecan are the most active agents in recurrent HB. Stem cell transplantation and radiation therapy have been reported in several patients with unclear successes. Advances in therapy for relapsed patients require concentrating enrollment in one or two phase I/II trials utilizing agents with promising preclinical data.
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Affiliation(s)
- Angela D Trobaugh-Lotrario
- Department of Pediatric Hematology/Oncology, Sacred Heart Children's Hospital, Spokane, Washington 99204, USA.
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13
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Venkatramani R, Furman WL, Fuchs J, Warmann SW, Malogolowkin MH. Current and future management strategies for relapsed or progressive hepatoblastoma. Paediatr Drugs 2012; 14:221-32. [PMID: 22702740 DOI: 10.2165/11597740-000000000-00000] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hepatoblastoma is the most common primary malignant neoplasm of the liver in children. Improvements in chemotherapy and surgical techniques have increased survival rates for those with localized disease. The prognosis for patients with progressive or relapsed disease continues to be dismal. Complete resection by surgery or liver transplantation is necessary for cure. Few conventional chemotherapy agents have demonstrated activity in progressive or relapsed hepatoblastoma. Irinotecan has shown activity in relapsed and progressive hepatoblastoma. The efficacy of high-dose chemotherapy in this setting is unknown. Newer targeted agents that 'selectively' interfere with pathway targets involved in tumor growth and progression such as insulin-like growth factor, phosphatidylinositol 3-kinase (PI3K), Akt, and mammalian target of rapamycin (mTOR) are currently under development. Because of the rarity of hepatoblastoma, only a small minority of these agents will ever be evaluated in children with this disorder. Gene-directed therapy and immunotherapy have shown promising results in the preclinical setting, and should be investigated as future treatment options for advanced hepatoblastoma.
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14
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Miyamura T, Yoshida R, Yagi T, Matsukawa H, Chayama K, Ishida T, Washio K, Morishita N, Oda M, Morishima T. Successful treatment of unresectable advanced hepatoblastoma: living liver transplantation after surgical removal of lung metastasis. Pediatr Transplant 2011; 15:E87-91. [PMID: 20070564 DOI: 10.1111/j.1399-3046.2009.01262.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hepatoblastoma is a rare malignant tumor of the liver in children. Intensive combination chemotherapy has increased the number of surgically resectable cases and improved prognosis markedly. However, unresectable cases and cases with residual metastasis, including lung metastases, have a poor prognosis. In these refractory cases, treatment strategy has not been established. On the other hand, living liver transplantation has been shown to be effective in cases of advanced hepatoblastoma, but its effectiveness in cases with residual distant metastases after chemotherapy remains unclear. We report one successful case of advanced unresectable hepatoblastoma with multiple lung metastases. Intensive chemotherapy consisting of high-dose chemotherapy with autologous hematopoietic stem cell transplantation was not effective. We performed living liver transplantation after surgical resection of residual lung metastases, which were histologically viable. After liver transplantation, the level of tumor marker decreased gradually. The patient experienced no severe complications. This case suggested that living liver transplantation could be effective in cases of advanced refractory hepatoblastoma after control of distant metastases.
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Affiliation(s)
- Takako Miyamura
- Department of Pediatrics, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
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15
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Sieswerda E, Kremer LCM, Caron HN, van Dalen EC. The use of liposomal anthracycline analogues for childhood malignancies: A systematic review. Eur J Cancer 2011; 47:2000-8. [PMID: 21514819 DOI: 10.1016/j.ejca.2011.03.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 02/22/2011] [Accepted: 03/21/2011] [Indexed: 11/28/2022]
Abstract
In an effort to prevent or reduce anthracycline-induced cardiotoxicity, liposomal anthracyclines have been developed. The objective of this systematic review was to summarise all available evidence on the benefits and risks of liposomal anthracyclines in children with cancer. We searched databases (MEDLINE (1966-September 2009), EMBASE (1980-September 2009) and CENTRAL (The Cochrane Library, issue 3 2009)), reference lists of relevant articles and ongoing trial databases for relevant studies. Two reviewers independently performed study selection, data extraction and quality assessment of included studies. No randomised controlled trials (RCTs) or controlled clinical trials (CCTs) were found. Fifteen observational studies described the use of liposomal anthracyclines in children with cancer. Most patients had been treated extensively in the past. Some patients developed cardiotoxicity, serious allergic reactions, mucositis, infections, hematotoxicities and/or hepatotoxicity after single agent treatment. However, due to the low quality of the currently available research, it is unclear what the exact risks are. In conclusion, there is no evidence available from RCTs or CCTs about the benefits and risks of liposomal anthracyclines in children with cancer. Limited data from observational studies suggest that children treated with liposomal anthracyclines are at risk for developing cardiotoxicity and other serious toxicities. There is an urgent need for results of well-designed studies which accurately evaluate the benefits and risks of liposomal anthracyclines in children with cancer. Until high quality evidence is available, we recommend monitoring of cardiac function in childhood cancer patients treated with a liposomal anthracycline and awareness of other serious toxicities.
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Affiliation(s)
- E Sieswerda
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
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16
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Hishiki T, Matsunaga T, Sasaki F, Yano M, Ida K, Horie H, Kondo S, Watanabe KI, Oue T, Tajiri T, Kamimatsuse A, Ohnuma N, Hiyama E. Outcome of hepatoblastomas treated using the Japanese Study Group for Pediatric Liver Tumor (JPLT) protocol-2: report from the JPLT. Pediatr Surg Int 2011; 27:1-8. [PMID: 20922397 DOI: 10.1007/s00383-010-2708-0] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In the recent years, surgical resection with pre- and/or postoperative chemotherapy has markedly improved the survival rate of hepatoblastoma patients. We herein report the results of patients treated with the current protocol of the Japanese Study Group for Pediatric Liver Tumor, JPLT-2. METHODS A total of 279 patients with malignant liver tumor were enrolled in JPLT-2. Data from 212 hepatoblastoma cases were analyzed. PRETEXT I patients were treated with primary resection followed by low doses of cisplatin-pirarubicin (tetrahydropyranyl-adriamycin). Otherwise, patients received preoperative cisplatin-pirarubicin (CITA), followed by surgery and postoperative chemotherapy. Ifosfamide, pirarubicin, etoposide, and carboplatin (ITEC) were given as a salvage treatment. High-dose chemotherapy with hematopoietic stem cell transplantation (SCT) was reserved for patients with metastatic diseases. RESULTS The 5-year overall survival rate (OS) in non-metastatic cases was 100% for PRETEXT I, 87.1% for PRETEXT II, 89.7% for PRETEXT III, and 78.3% for PRETEXT IV. The 5-year OS in metastatic cases was 43.9%. The outcome in non-metastatic PRETEXT IV cases was markedly improved, while the results of metastatic tumors remained poor. CONCLUSIONS JPLT-2 protocol achieved satisfactory survival among children with non-metastatic hepatoblastoma. New approaches are needed for patients with metastatic diseases.
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Affiliation(s)
- Tomoro Hishiki
- Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, 260-8677, Japan,
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17
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Qayed M, Powell C, Morgan ER, Haugen M, Katzenstein HM. Irinotecan as maintenance therapy in high-risk hepatoblastoma. Pediatr Blood Cancer 2010; 54:761-3. [PMID: 20063426 DOI: 10.1002/pbc.22408] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Children with high-risk hepatoblastoma (metastatic disease or a low alpha-fetoprotein at presentation) and those with recurrent disease have an extremely poor prognosis and are in need of novel therapeutic agents and strategies. We describe three patients who were treated with irinotecan (two in combination with vincristine). In two patients, this contributed to a clinical remission. All three patients received a 1- to 2-year course of irinotecan as maintenance therapy and all remain disease free. Treatment was well tolerated with minimal toxicity. Further evaluation of the use of irinotecan as maintenance therapy in high-risk and recurrent HB patients is warranted.
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Affiliation(s)
- Muna Qayed
- Aflac Cancer Center, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
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18
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Finegold MJ, Egler RA, Goss JA, Guillerman RP, Karpen SJ, Krishnamurthy R, O'Mahony CA. Liver tumors: pediatric population. Liver Transpl 2008; 14:1545-56. [PMID: 18975283 DOI: 10.1002/lt.21654] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Liver tumors in childhood are rare and are typically not detected clinically until they reach a large size and often spread within the organ or metastasize. This can make surgical resection problematic, and almost all of them require extirpation for cure. With very effective chemotherapy for hepatoblastoma and to some extent for sarcomas, many cancers can be shrunk to permit partial hepatectomy, but for most hepatocarcinomas, some of the other malignancies, and even some benign proliferations, their location at the hilum and multiplicity of masses in multiple lobes make transplantation the treatment of choice. Major advances in diagnostic imaging, especially enhanced computed tomography and magnetic resonance imaging, permit a preoperative choice of resection versus transplantation to be achieved in almost all instances, and for the remainder, intraoperative ultrasonography can further help to determine the most desirable approach. The outcome is very much better in the case of hepatoblastoma when transplantation is a primary modality rather than following unsuccessful attempts at resection. In this review, transplantation for liver tumors in children is considered from all aspects, including the importance of screening for tumors whenever possible to avoid the need for transplantation.
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19
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Kushner BH, Kramer K, Modak S, Cheung NKV. Irinotecan Plus Temozolomide for Relapsed or Refractory Neuroblastoma. J Clin Oncol 2006; 24:5271-6. [PMID: 17114661 DOI: 10.1200/jco.2006.06.7272] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To report on an irinotecan and temozolomide regimen for neuroblastoma (NB). Quality of life and minimizing toxicity were major considerations. Patients and Methods The plan stipulated 5-day courses of irinotecan 50 mg/m2 (1-hour infusion) and temozolomide 150 mg/m2 (oral) every 3 to 4 weeks, with a pretreatment platelet count more than 30,000/μL. Granulocyte colony-stimulating factor was used when the absolute neutrophil count was less than 1,000/μL. Results Forty-nine NB patients received 1 to 15 courses (median, 5). Gastrointestinal and myelosuppressive toxicities were readily managed. Lymphocyte responses to phytohemagglutinin after 2 to 10 courses (median, 3.5) were normal in 10 of 10 patients treated after nonimmunosuppressive therapy, and normalized in five of seven patients first treated less than 2 months after high-dose alkylators. Of 19 patients treated for refractory NB and assessable for response, nine showed evidence of disease regression, including two complete responses and seven objective responses. Of 17 patients treated for progressive disease, three showed evidence of disease regression, including one partial response and two objective responses. Multiple courses entailed no cumulative toxicity and controlled disease for prolonged periods in many patients, including some who were unable to complete prior treatments because of hematologic, infectious, cardiac, or renal problems. Conclusion This regimen has anti-NB activity, spares vital organs, is feasible with poor bone marrow reserve, causes limited immunosuppression, and allows good quality of life.
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Affiliation(s)
- Brian H Kushner
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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20
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Inaba H, Handgretinger R, Furman W, Hale G, Leung W. Allogeneic graft-versus-hepatoblastoma effect. Pediatr Blood Cancer 2006; 46:501-5. [PMID: 15806543 DOI: 10.1002/pbc.20404] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although the survival rate for pediatric patients with hepatoblastoma has improved, prognosis is still poor when the disease is unresectable and refractory to chemotherapy. Therefore, novel approaches are warranted. Herein, we describe a patient with recurrent metastatic hepatoblastoma who received a non-myeloablative hematopoietic stem cell transplantation from an HLA-matched unrelated donor. After withdrawal of immunosuppressant and establishment of full donor T-cell engraftment, the tumor regressed and serum alpha-fetoprotein level decreased in concurrence with the onset of graft-versus-host disease (GVHD). Her disease recurred when GVHD resolved. This patient's clinical course provides evidence for the probable existence of allogeneic graft-versus-hepatoblastoma effect.
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Affiliation(s)
- Hiroto Inaba
- Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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Inagaki J, Yasui M, Sakata N, Inoue M, Yagi K, Kawa K. Successful treatment of chemoresistant stage 3 neuroblastoma using irinotecan as a single agent. J Pediatr Hematol Oncol 2005; 27:604-6. [PMID: 16282892 DOI: 10.1097/01.mph.0000187430.60240.09] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors describe a 1-year-old boy who was diagnosed with neuroblastoma by mass screening at age 6 months. The tumor originated from the left retroperitoneum and extended over the midline, involving major vessels and invading the spine with compression of the spinal cord. Although seven courses of chemotherapy consisting of vincristine sulfate, cyclophosphamide, pirarubicin hydrochloride, and cisplatin were administered, there was no reduction in tumor size or decrease in tumor markers. The patient received irinotecan 180 mg/m per day for 3 days. Approximately 3 weeks later the tumor had regressed remarkably, and tumor markers normalized after the second course of irinotecan. This therapy was given a total of four courses every 4 weeks, with the tumor shrinking successively in each session. Four years after treatment there is no sign of recurrence and the patient is doing well. This case may be the first report showing the dramatic efficacy of irinotecan in the treatment of chemoresistant neuroblastoma without the use of other antitumor agents. Irinotecan might be a promising drug in the management of patients with high-risk neuroblastoma.
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Affiliation(s)
- Jiro Inagaki
- Section of Pediatrics, National Kyusyu Cancer Center, Fukuoka, Japan.
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22
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Kasahara M, Ueda M, Haga H, Hiramatsu H, Kobayashi M, Adachi S, Sakamoto S, Oike F, Egawa H, Takada Y, Tanaka K. Living-donor liver transplantation for hepatoblastoma. Am J Transplant 2005; 5:2229-35. [PMID: 16095502 DOI: 10.1111/j.1600-6143.2005.01003.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Hepatoblastoma is the most common malignant liver tumor in children. Recently, liver transplantation has been indicated for unresectable hepatoblastoma. We retrospectively reviewed 14 children with a diagnosis of hepatoblastoma who had undergone living-donor liver transplantation (LDLT) at Kyoto University Hospital. During the period from June 1990 to December 2004, 607 children underwent LDLT. Of these interventions, 2.3% were performed for hepatoblastoma. Based on radiological findings, the pre-treatment extent of disease (PRETEXT) grouping was used for pre-treatment staging of the tumor. There were grade III in seven patients and grade IV in seven patients. Thirteen patients received chemotherapy, and seven underwent hepatectomy 11 times. Immunosuppressive treatment consisted of tacrolimus monotherapy in 11 patients. Actuarial 1- and 5-year graft and patient survival rates were 78.6% and 65.5%. The poor prognostic factors were macroscopic venous invasion and extrahepatic involvement with 1-year and 5-year survival rates of 33.0% and 0%. Pediatric patients without these factors showed an acceptable 5-year survival rate of 90.9%. LDLT provides a valuable alternative with excellent results in children with hepatoblastoma because it allows optimal timing of the liver transplantation, given the absence of delay between the completion of chemotherapy and planned liver transplantation.
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Affiliation(s)
- Mureo Kasahara
- Organ Transplant Unit, Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan.
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Casanova M, Massimino M, Ferrari A, Spreafico F, Piva L, Coppa J, Luksch R, Cefalo G, Terenziani M, Polastri D, Bellani FF, Mazzaferro V. Etoposide, cisplatin, epirubicin chemotherapy in the treatment of pediatric liver tumors. Pediatr Hematol Oncol 2005; 22:189-98. [PMID: 16020101 DOI: 10.1080/08880010590921441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To discuss the potential benefit of a chemotherapy regimen including etoposide (etoposide, cisplatin, epirubicin [EPE]), the authors report a single-institutional experience regarding 13 children with hepatoblastoma (HB) and 7 with hepatocellular carcinoma (HCC). Chemotherapy achieved partial response in 8/9 HB and in 4/5 HCC. Eight initially unresectable HB subsequently had liver resection. Event-free survival and overall survival at 5 years were 84 and 88% for HB (non-metastatic cases: 91 and 100%), 29% for HCC. EPE chemotherapy seems to be effective in the treatment of childhood malignant liver tumors. Etoposide could be suggested as part of intensive multidrug regimens for HCC and high-risk HB.
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Affiliation(s)
- Michela Casanova
- Pediatric Oncology Unit, Istituto Nazionale Tumori, Via Venezian, 1-20133 Milano, Italy.
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Kushner BH, Kramer K, Modak S, Cheung NKV. Five-day courses of irinotecan as palliative therapy for patients with neuroblastoma. Cancer 2005; 103:858-62. [PMID: 15637685 DOI: 10.1002/cncr.20846] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The authors describe a large experience using short courses of irinotecan for palliative therapy in patients with neuroblastoma (NB). Quality of life was a major issue in choosing this regimen for patients whose disease was resistant to standard anti-NB therapies. METHODS A retrospective review was conducted of all patients who were followed by the Department of Pediatrics at Memorial Sloan-Kettering Cancer Center and treated for resistant NB with irinotecan at 50 mg/m2 per day for 5 days as a 1-hour intravenous infusion. Treatment was outpatient, and there was a minimum 2-week rest period between courses. Granulocyte colony-stimulating factor was used to keep the absolute neutrophil count >500-1000/mL. RESULTS Forty-four patients had been treated aggressively and/or extensively before they received one or more five-day courses of irinotecan. Emetogenic, diarrheal, and myelosuppressive effects were readily managed. Hospitalizations were limited to three patients with bacteremia. Twenty-three patients had a change in therapy, although they did not have progressive disease (PD) after receiving 1 (n=10), 2 (n=3), 3 (n=1), 4 (n=6), 7 (n=1 patient), 22 (n=1 patient), or 24 (n=1) courses. The most common reasons for changing treatment were to intensify retrieval therapy or to pursue immunotherapy. Of those 23 patients, 15 patients had stable disease, 7 were not evaluable for response because of concurrent radiotherapy, and 1 patient had a major response. Twenty-one patients had PD after 1 (n=3, 2 (n=9), 4 (n=2), 5 (n=1), 6 (n=3), 7 (n=1), 9 (n=1), and 11 (n=1) courses. CONCLUSIONS In heavily treated patients, the regimen studied was well tolerated, allowed patients to continue most normal life activities, and produced anti-NB effects. Its modest toxicity supported use with other antitumor agents.
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Affiliation(s)
- Brian H Kushner
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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van den Berg H. Biology and therapy of malignant solid tumors in childhood. ACTA ACUST UNITED AC 2005; 22:643-76. [PMID: 16110632 DOI: 10.1016/s0921-4410(04)22028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Henk van den Berg
- Department of Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, The Netherlands.
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