Combination chemotherapy in the treatment of hepatoblastoma

Hepatoblastoma metastatic to brain: prolonged survival after multiple surgical resections of a solitary brain lesion

PURPOSE

Pulmonary metastases of hepatoblastoma confined to the lung have been cured using therapy that included radical surgical resection. We report the case of a child with a hepatoblastoma metastatic to brain that was successfully treated with multiple surgical resections, irradiation, and chemotherapy. The case demonstrates that such an approach, employing aggressive surgery, can produce durable remission of an extrapulmonary metastasis with hepatoblastoma.

PATIENTS AND METHODS

A 17-month-old girl presented with a hepatoblastoma that remained unresectable after chemotherapy and irradiation and underwent orthotopic liver transplantation 14 months after diagnosis. After twice undergoing surgical resections of pulmonary metastases 22 and 31 months from diagnosis, 1 month later (32 months from diagnosis), she developed a solitary metastatic right brain lesion that later recurred twice in the same location, 5 and 6 years from initial diagnosis. Each time she underwent surgical resection of the brain lesion and received local irradiation after the first two resections and chemotherapy after the third. At the last surgery, resection was continued until histologically negative tumor margins were obtained.

RESULTS

The child is currently without evidence of disease or neurological deficit 10.5 years from initial diagnosis.

CONCLUSION

The durable remission achieved after multiple resections of the recurrent solitary cerebral metastasis in this child demonstrates that an aggressive surgical approach to extrapulmonary metastases in such a setting can contribute to prolonged survival, just as has been shown with isolated metastatic pulmonary disease.