J Pediatr Surg 1997 Jul;32(7):999-1002; discussion 1002-3

Improved long-term survival with preoperative chemotherapy for hepatoblastoma

Ehrlich PF, Greenberg ML, Filler RM

Department of Surgery, Hospital for Sick Children, University of Toronto,
Ontario, Canada

Abstract
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 all children who had
hepatoblastoma. Of 25 children who presented with hepatoblastoma, 22 were
eligible for protocol therapy. After percutaneous biopsy, cycles of cisplatin
(20 mg/m2/d for 5 days) and Adriamycin (25 mg/m2/d for 3 days) were administered
every 3 weeks by continuous intravenous infusion. A CAT scan was performed after
the third cycle. Surgery was undertaken if response indicated that complete
resection was possible. If not, a further one to three cycles were given until
response was adequate. Postoperatively, therapy was continued for a total of six
cycles. Twenty of twenty-two (91%) tumors responded to chemotherapy. Over half
required only three cycles. Twenty hepatic resections (6 segmentectomies, 10
lobectomies, 4 trisegmentectomies) were performed. Preoperative therapy
significantly reduced the extent of resection calculated to be necessary for
complete excision at an initial diagnosis of the primary tumor in all but one.
In the two children with 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 by metastatic
lung disease at 22 and 26 months, respectively. Twelve children, eight with
tumors that would have been unresectable before effective chemotherapy, have had
follow-up for more than 5 years. This protocol of preoperative chemotherapy
appears to be safe and effective for most children who have hepatoblastoma