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Feasibility and Toxicity of Chemoembolization for Children With Liver Tumors

From the Departments of Pediatrics and Radiology, University of Southern California School of Medicine, and Division of Hematology/Oncology, University of California Los Angeles, Los Angeles, CA.

Address reprint requests to Marcio H. Malogolowkin, MD, University of California Los Angeles School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, University of California Los Angeles Medical Center, 10833 Le Conte Ave, Los Angeles, CA 90024-1752; email mmalogol{at}ucla.edu

PURPOSE: To determine the feasibility, toxicity, and efficacy of hepatic arterial chemoembolization (HACE) in pediatric patients with refractory primary malignancies of the liver.

PATIENTS AND METHODS: Six patients with hepatoblastoma (HB), three with hepatocellular carcinoma (HCC), and two with undifferentiated sarcoma of the liver were treated with HACE every 2 to 4 weeks until their tumors became surgically resectable or they showed signs of disease progression. All but one newly diagnosed patient with HCC had previously received systemic chemotherapy.

RESULTS: All patients with HB and HCC responded to HACE, as measured by imaging studies and alpha-fetoprotein levels. Surgical resection (complete or microscopic residual disease) was feasible in five of 11 patients, and three patients remain alive with no evidence of disease. Elevated liver transaminase and bilirubin levels were seen after each one of the 46 courses of HACE. Other toxicities included fever, pain, nausea, vomiting, and transient coagulopathy.

CONCLUSION: HACE is feasible, well tolerated, and effective in inducing surgical resectability of primary hepatic tumors in children.

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