Use of intrahepatic chemotherapy to treat advanced pediatric hepatic malignancies

Background: To evaluate the effect of intrahepatic arterial chemotherapy (I AC) on children with primary hepatic malignancies. Method: A nonrandomized inception cohort of 11 pediatric patients was refer red for treatment of advanced primary hepatic malignancies at Children's Ho spital of Pittsburgh. None of the patients was a candidate for resection be fore the initiation of IAC. Tumor response to treatment was observed by det ermining serum alpha-fetoprotein (AFP) levels and by abdominal computed tom ographic scan. The patients received hepatic artery infusions of cisplatin and/or doxorubicin. The last five also received gelfoam embolization. Results: Eight of 11 patients had multiple IAC treatments. Eight patients h ad AFP-producing tumors, and five of the eight had dramatic reductions in s erum levels after IAC treatment. Five of the 11 patients underwent successf ul orthotopic liver transplantation after receiving IAC therapy, and the fi ve explanted specimens showed varying degrees of tumor necrosis. One-year s urvival in patients in the authors' center is 67% for those with hepatoblas toma and 40% for those with hepatocellular carcinoma. Three-year survival i s 60% and 30% for patients with hepatoblastoma and hepatocellular carcinoma , respectively. Conclusion: Intrahepatic arterial chemotherapy therapy can halt the progres sion and possibly down-stage advanced pediatric hepatic malignancies. This therapy can also be used as a successful adjunct in altering a patient's ch ance for successful liver transplantation.