IMPROVED LONG-TERM SURVIVAL WITH PREOPERATIVE CHEMOTHERAPY FOR HEPATOBLASTOMA

In 1986, The Hospital for Sick Children (Toronto, Canada) began to use a standard preoperative chemotherapeutic regimen for patients who had unresectable hepatoblastoma. In 1988, we extended this protocol to al l children who had hepatoblastoma. Of 25 children who presented with h epatoblastoma, 22 were eligible for protocol therapy. After percutaneo us biopsy, cycles of cisplatin (20 mg/m(2)/d for 5 days) and Adriamyci n (25 mg/m(2)/d for 3 days) were administered every 3 weeks by continu ous intravenous infusion. A CAT scan was performed after the third cyc le. Surgery was undertaken if response indicated that complete resecti on was possible. If not, a further one to three cycles were given unti l response was adequate. Postoperatively, therapy was continued for a total of six cycles. Twenty of twenty-two (91%) tumors responded to ch emotherapy. Over half required only three cycles, Twenty hepatic resec tions (6 segmentectomies, 10 lobectomies, 4 trisegmentectomies) were p erformed. Preoperative therapy significantly reduced the extent of res ection calculated to be necessary for complete excision at an initial diagnosis of the primary tumor in all but one. In the two children wit h inadequate response, total hepatectomy and transplant was necessary for complete resection. No deaths or operative delays were attributed to chemotherapy toxicity. Nineteen of 22 children (87%) are alive with no evidence of disease, including both transplant patients. One death was caused by intraoperative bleeding and the other two were caused b y metastatic lung disease at 22 and 26 months, respectively. Twelve ch ildren, eight with tumors that would have been unresectable before eff ective chemotherapy, have had follow-up for more than 5 years. This pr otocol of preoperative chemotherapy appears to be safe and effective f or most children who have hepatoblastoma. Copyright (C) 1997 by W.B. S aunders Company.