Pre-Operative Chemo Appears to Improve Treatment for Childhood Hepatoblastoma

Hepatoblastoma is a rare childhood cancer of the liver.

Through complete surgical removal of the cancer, high cure rates may be achieved in patients with this disease. A recent report published in the

Journal of Clinical Oncology suggests that chemotherapy prior to surgery may enhance the chance of complete surgical removal of the cancer, ultimately improving the outcome for patients with hepatoblastoma.

The liver is the largest organ in the body and is responsible for over 500 functions, including the secretion of glucose, proteins, vitamins and fats, the production of bile, the processing of hemoglobin and the detoxification of numerous substances. Hepatoblastoma is a type of liver cancer that develops in children, with the majority of cases occurring in children less than 3 years old. It differs from liver cancers found in adults in that the cancer arises from a different type of cell in the liver. Hepatoblastoma is thought to be caused by a specific genetic mutation.

Currently, the only curative option for hepatoblastoma is surgery to remove the cancer. The highest cure rates are achieved when the cancer can be completely surgically removed. However, the cancer has often spread throughout the body or has replaced too much of the liver to allow for complete surgical removal. These patients have a poorer prognosis following treatment.

The International Society of Paediatric Oncology (SIOP) has recently evaluated a treatment strategy involving chemotherapy prior to surgery in patients with hepatoblastoma. There are three separate reasons for the use of this treatment strategy: 1) pre-operative chemotherapy can shrink some hepatoblastoma cancers, and therefore may allow more complete surgical removal of the cancer; 2) surgery involving the removal of a smaller cancer is less extensive and may decrease complications associated with extensive surgery; 3) immediate chemotherapy kills cancer cells that may have spread away from the liver without delay.

In a large clinical study conducted by SIOP, treatment outcomes involving almost 140 patients with hepatoblastoma were evaluated. All of these patients received chemotherapy consisting of cisplatin and doxorubicin prior to surgery. Eighty- two percent of the patients showed partial or complete disappearance of cancer following chemotherapy treatment. Importantly, this allowed 106 patients to have their cancer completely removed during surgery. Five years following treatment, almost 70% of the patients survived without return of their cancer. This treatment strategy was well tolerated.

These results indicate that pre-operative chemotherapy in patients with hepatoblastoma may improve the chance of complete surgical removal of cancer. This provides optimal chances for a cure. These results were achieved by participation in the SIOP trial and future progress will be made by continued participation in these trials. Parents with children who have hepatoblastoma need to discuss current ongoing clinical trials with their physicians.

(Journal of Clinical Oncology, Vol 18, Issue 22, pp 3819-3828, 2000)

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