J Pediatr Surg 1994 Oct;29(10):1319-22

Pretransplant chemotherapy in pediatric hepatocellular carcinoma

Broughan TA, Esquivel CO, Vogt DP, Griffin GC, Norris DG

Cleveland Clinic Foundation, OH

Abstract
The prognosis for pediatric patients with hepatocellular carcinoma is poor,
except for fewer than half the patients, who can be rendered disease-free with
conventional liver resection. Multicentric, bilobar liver cancer remains
unresectable, even after radiation and chemotherapy. Liver transplantation alone
for primary hepatic cancer has had limited success. Chemotherapy has been
reserved for use after transplantation, with little demonstrable benefit. A
pilot program of pretransplant chemotherapy was undertaken. Four adolescent
patients with unresectable, multicentric, bilobar hepatocellular carcinoma were
staged noninvasively, underwent chemotherapy followed by a final staging
laparotomy, and then had liver transplantation. Three of the four patients
survived and have no evidence of recurrence 84, 67, and 47 months after
diagnosis and 76, 65, and 44 months after transplantation. Pretransplant
chemotherapy has four potential advantages: (1) minimized risk of posttransplant
opportunistic infections, (2) less tumor bulk at the time of transplantation,
(3) fewer local recurrences, and (4) a lower rate of metastasis