Jm. Wheatley et Mp. Laquaglia, MANAGEMENT OF HEPATIC EPITHELIAL MALIGNANCY IN CHILDHOOD AND ADOLESCENCE, Seminars in surgical oncology, 9(6), 1993, pp. 532-540
This review addresses the management of epithelial liver tumors of chi
ldhood and adolescence (hepatoblastoma and hepatocellular carcinoma),
which constitute approximately 90% of primary liver malignancy in this
age group. The epidemiology, pathology, clinical presentation, and di
agnosis are given in order to appreciate differences in biological beh
avior of these two neoplasms and the need for a distinct therapeutic a
pproach to each. The multidisciplinary treatment of hepatoblastoma has
become increasingly refined and long-term survival can be expected in
approximately 80% of patients. Where survival once depended solely on
complete surgical resection, it is now also possible in patients with
initially unresectable tumors due to effective cytoreductive chemothe
rapy. The problem of systemic relapse following complete surgical rese
ction has been reduced although not eliminated by adjuvant chemotherap
y programs. To date, the biological behavior of hepatocellular carcino
ma prohibits complete resection in the majority of children and chemot
herapy has not been effective. Early detection, development of new age
nts and techniques such as monoclonal antibodies and total hepatectomy
with autologous transplantation in selected cases may offer hope for
the future. (C) 1993 Wiley-Liss, Inc.