All issues > Volume 38(2); 1995

Original Article

J Korean Pediatr Soc. 1995;38(2):195-206. Published online February 15, 1995.

Results of Chemotherapy of Hepatoblastoma and Hepatocellular Carcinoma in Children

Kyung Duk KD Park¹, Gi Woong GW Seong¹, Jae Kyung JK Lee¹, Hong Hoe HH Koo¹, Hee Young HY Shin¹, Hyo Seop HS Ahn¹

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

Abstract

Purpose
: Surgical excision has been the primary treatment for hepatoblastoma and hepatocellular carcinoma. However, at presentation, only one third of such tumors are surgically resectable. Without operation, the disease is fatal. Therefore, neoadjuvant chemotherapy has been introduced for conversion of the unresectable tumors into the resectable ones. We studied th e effects of chemotherapy for hepatic malignancy in children.
Methods
: Between November 1986 and August 1993, 30 children presented with hepatob lastomas or heptocellular carcinoma, which were diagnosed by histology. We analysed the laboratory findings of hepatic tumors and the outcome of chemotherapy.
Results
: Laboratory findings revealed mild anemia, elevated SGOT/SGPT, and extremely increased AFP level. Twenty-six among 30 patients entered into surgery or neoadjuvant chemotherapy. Initial complete resection of tumor was attempted in 11 case, and was successful in 9 cases. Fifteen cases with initially unresectable tumors were treated with chemotherapy including cisplatin and/or doxorubicin. Nine of 15 showed significant reduction in tumor size, and delayed resection of the primary lesion was possible. But one case did not respond to chemotherapy, and 5 cases was droped out due to death(n=2) and refusal of chemotherapy(n=3). Twenty p atients were enrolled in survival analysis. Overall 3 year survival rate was 61%, and 2 year su rvival rates of hepatoblastoma and hepatocellular carcinoma were 85% and 33% respectively(P=0.06). According to the stage, 2 year survival rate of stage I and III were 87% and 75% respectively. None of patient with metastasis survived at 16 months. Chemotherapy was tolerable in most patients and its principal toxicities were myelosuppression and fever. Three patients developed decreased left ventricular shortening fraction and their cumulative dose of doxorubicin were 771mg/m2, 557mg/ m2, and 390mg/ m2.
Conclusion
: Chemotherapy including cisplatin and/or doxorubicin is an effective treatment in inducing surgical resectability in hepatoblastomas which are unresectable at diagnosis.

Keywords :Hepatoblastoma, Hepatocellular carcinoma, Childhood, Chemotherapy, Survival rate