Liver transplantation for hepatoblastoma: Indications and contraindications in the modern era
- 3 September 2005
- journal article
- Published by Wiley in Pediatric Transplantation
- Vol. 9 (5), 557-565
- https://doi.org/10.1111/j.1399-3046.2005.00354.x
Abstract
In the past 20 yr, a dramatic improvement has been achieved in the outcome of children with hepatoblastoma by combining cisplatin based chemotherapy and surgery. Treatment of patients in the USA is an exception to the rule that all patients should receive neoadjuvant chemotherapy. It is paramount that surgical resection be complete, both macro- and microscopically. Complete tumor resection can be achieved after chemotherapy with a partial hepatectomy when the intrahepatic extent is limited to 1-3 sectors. In multifocal (and solitary) hepatoblastomas invading all four liver sectors, and in centrally located tumors with close proximity to the major veins, the SIOPEL-1 study and an extensive review of the world experience have shown that primary transplantation provides high, long term, disease-free survival rate in the range of 80%. In contrast, the results of rescue transplants for incomplete tumor resection or disease recurrence after partial hepatectomy are disappointing (in the range of 30%). Hazardous attempts at partial hepatectomy in children with extensive hepatoblastoma should be discouraged. Guidelines are provided for early referral of children with extended hepatoblastoma to a transplant surgeon. There is a trend for a better patient survival after living related liver transplantation. Patients who will become candidates to liver transplantation should be treated with chemotherapy following the same protocols as for children undergoing a partial hepatectomy. There is a concern about cumulative nephrotoxicity of calcineurin inhibitors and chemotherapeutic drugs. Recent data suggest that these patients tolerate lower Tacrolimus trough blood levels than those transplanted for non-malignant conditions, without increasing the risk of acute rejection. Due to the rarity of the disease, these children should be treated in specialized centers.Keywords
This publication has 27 references indexed in Scilit:
- 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 StudyJournal of Clinical Oncology, 2005
- Risk-adapted treatment for childhood hepatoblastoma: final report of the second study of the International Society of Paediatric Oncology—SIOPEL 2European Journal of Cancer, 2004
- Liver transplantation for hepatoblastoma: Results from the International Society of Pediatric Oncology (SIOP) study SIOPEL‐1 and review of the world experiencePediatric Blood & Cancer, 2003
- Liver TumorsSeminars in Pediatric Surgery, 2000
- Cisplatin, Doxorubicin, and Delayed Surgery for Childhood Hepatoblastoma: A Successful Approach—Results of the First Prospective Study of the International Society of Pediatric OncologyJournal of Clinical Oncology, 2000
- SIOPEL trials using preoperative chemotherapy in hepatoblastomaThe Lancet Oncology, 2000
- Randomized Comparison of Cisplatin/Vincristine/Fluorouracil and Cisplatin/Continuous Infusion Doxorubicin for Treatment of Pediatric Hepatoblastoma: A Report From the Children’s Cancer Group and the Pediatric Oncology GroupJournal of Clinical Oncology, 2000
- Pretreatment prognostic factors for children with hepatoblastoma — results from the International Society of Paediatric Oncology (SIOP) Study SIOPEL 1European Journal of Cancer, 2000
- Efficiency and toxicity of ifosfamide, cisplatin and doxorubicin in the treatment of childhood hepatoblastomaEuropean Journal of Cancer, 1997
- Alpha feto (αFP) monitoring of response to adriamycin in hepatoblastomaJournal of Pediatric Surgery, 1982