TY - JOUR
T1 - Chemotherapy can convert unresectable hepatoblastoma
AU - Reynolds, M.
AU - Douglass, E. C.
AU - Finegold, M.
AU - Cantor, A.
AU - Glicksman, A.
N1 - Funding Information:
From the Children’s Memorial Hospital, Chicago, IL; St Jude Children’s Hospital, Memphis, TN; Texas Children’s Hospital, Houston, TX; Pediatric Oncology Group Statistical office, Gainesville, FL; and the New England Pediatric Oncology Consortium, Providence, RI. Supported in part by grants from the National Cancer Institute and the National Institutes of Health (CA-30969, CA-29139, CA-07431, CA-31566, CA-03161, and CA-29293). Presented at the 43rd Annual Meeting of the Surgical Section of the American Academy of Pediatrics, New Orleans, Louisiana, October 26-27, 1991. Address reprint requests to Marleta Reynolds, MD, POG Protocol no. 8697, Pediatric Oncology Group, 4949 WPine Blvd, St Louis, MO 63108. Copyrtgh t o I992 by W B. Saunders Company 0022-3468/92/2708-0029$03.00/O
PY - 1992/8
Y1 - 1992/8
N2 - The surgical evaluation and management of children with hepatoblastoma has changed with recent advances in imaging modalities and preoperative chemotherapy. Pediatric Oncology Group (POG) Study no. 8697 has followed 63 patients with hepatoblastoma from 1986 to 1991. Twenty-six patients underwent primary tumor resection followed by chemotherapy consisting of cisplatin, vincristine, and 5-fluorouracil (group I). Thirty-seven patients with "unresectable" tumors received preoperative chemotherapy. Twenty-nine of these patients responded to chemotherapy and 26 underwent delayed surgical resection (group II). Eight patients had an inadequate response to chemotherapy; two have had successful liver transplantation and six are dead of disease progression. "Unresectable tumor" involved both liver lobes (25 patients), encased the inferior vena cava (2), involved adjacent tissues (1), involved the hepatic veins (2), or was deemed too large for safe resection (7). Two patients had distant metastases. The reason for an unresectable designation was not reported in five patients. The determination for an unresectable designation included exploratory laparotomy in 14 patients, angiogram in 7, computed tomography scan in 20, and magnetic resonance imaging in 3 patients. Operative times and transfusion requirements were similar in both groups. Perioperative complications were higher in patients in group II. There was no mortality and only minor morbidity associated with chemotherapy in each group. In both groups 77% of the patients are in complete remission after 13 to 54 months. Preoperative chemotherapy can allow successful resection of initially "unresectable" hepatoblastoma. Primary resection that may result in exsanguination should be postponed and chemotherapy given.
AB - The surgical evaluation and management of children with hepatoblastoma has changed with recent advances in imaging modalities and preoperative chemotherapy. Pediatric Oncology Group (POG) Study no. 8697 has followed 63 patients with hepatoblastoma from 1986 to 1991. Twenty-six patients underwent primary tumor resection followed by chemotherapy consisting of cisplatin, vincristine, and 5-fluorouracil (group I). Thirty-seven patients with "unresectable" tumors received preoperative chemotherapy. Twenty-nine of these patients responded to chemotherapy and 26 underwent delayed surgical resection (group II). Eight patients had an inadequate response to chemotherapy; two have had successful liver transplantation and six are dead of disease progression. "Unresectable tumor" involved both liver lobes (25 patients), encased the inferior vena cava (2), involved adjacent tissues (1), involved the hepatic veins (2), or was deemed too large for safe resection (7). Two patients had distant metastases. The reason for an unresectable designation was not reported in five patients. The determination for an unresectable designation included exploratory laparotomy in 14 patients, angiogram in 7, computed tomography scan in 20, and magnetic resonance imaging in 3 patients. Operative times and transfusion requirements were similar in both groups. Perioperative complications were higher in patients in group II. There was no mortality and only minor morbidity associated with chemotherapy in each group. In both groups 77% of the patients are in complete remission after 13 to 54 months. Preoperative chemotherapy can allow successful resection of initially "unresectable" hepatoblastoma. Primary resection that may result in exsanguination should be postponed and chemotherapy given.
KW - Hepatoblastoma
KW - preoperative chemotherapy
KW - unresectable
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U2 - 10.1016/0022-3468(92)90564-N
DO - 10.1016/0022-3468(92)90564-N
M3 - Article
C2 - 1328586
AN - SCOPUS:0026722168
SN - 0022-3468
VL - 27
SP - 1080
EP - 1084
JO - Journal of pediatric surgery
JF - Journal of pediatric surgery
IS - 8
ER -