Feasibility and toxicity of chemoembolization for children with liver tumors

Purpose: To determine the feasibility, toxicity, and efficacy of hepatic ar terial chemoembolization (HACE) in pediatric patients with refractory prima ry malignancies of the liver. Patients and Methods: Six patients with hepatoblastoma (HB), three with hep atocellular carcinoma (HCC), and two with undifferentiated sarcoma of the l iver were treated with HACE every 2 to 4 weeks until their tumors became su rgically resectable or they showed signs of disease progression. All but on e newly diagnosed patient with HCC had previously received systemic chemoth erapy. Results: All patients with HE and HCC responded to MACE, as measured by ima ging studies and alpha-fetoprotein levels. Surgical resection (complete or microscopic residual disease) was feasible in five of 11 patients, and thre e patients remain alive with no evidence of disease. Elevated liver transam inase and bilirubin levels were seen after each one of the 46 courses of MA CE. Other toxicities included fever, pain, nausea, vomiting, and transient coagulopathy. Conclusion: HACE is feasible, well tolerated, and effective in inducing sur gical resectability of primary hepatic tumors in children. (C) 2000 by Amer ican Society of Clinical Oncology.