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Stage I and II Childhood Liver Cancer
Postsurgically staged, stage I and II and presurgically staged, PRETEXT stage 1, 2, and 3 hepatoblastoma
Stage I and II hepatocellular carcinoma

Postsurgically staged, stage I and II and presurgically staged, PRETEXT stage 1, 2, and 3 hepatoblastoma

Combination chemotherapy has been demonstrated to have significant benefit in children with hepatoblastoma. Cisplatin-based chemotherapy has resulted in a survival rate of greater than 90% for children with stage I and stage II disease.[1,2] Comparable results were obtained in an international study in which children were treated with doxorubicin/cisplatin chemotherapy prior to attempted resection of the liver tumor. In this study, 88% of the children in whom complete resection was achieved following the well-tolerated chemotherapy survived event-free 5 years after diagnosis.[3] In comparison, a survey of children with liver tumors treated prior to the consistent use of combination chemotherapy found that 45 of 78 patients with hepatoblastoma who had complete excision of the tumor survived.[4] A randomized clinical trial has demonstrated comparable efficacy with cisplatin/vincristine/fluorouracil and cisplatin/doxorubicin in the treatment of hepatoblastoma; the combination of cisplatin/vincristine/fluorouracil, however, resulted in considerably less toxicity.[5]

Treatment options
Complete surgical excision followed by 4 courses of combination chemotherapy with cisplatin, vincristine, and fluorouracil or comparable combination chemotherapy.[2] Completely excised tumor of purely fetal histology may be treated with doxorubicin alone [5] or carefully followed without further therapy.[2]

An alternative strategy for PRETEXT stage 2 and 3 hepatoblastoma is initial chemotherapy with 4 to 6 courses of doxorubicin/cisplatin chemotherapy followed by attempted resection. PRETEXT stage 1 tumors should be resected prior to treatment with postresection combination chemotherapy.[3]

Stage I and II hepatocellular carcinoma

Treatment options
In a randomized trial, 7 of 8 patients with stage I hepatocellular carcinoma survived disease free after adjuvant cisplatin-based chemotherapy.[6] In a survey of childhood liver tumors treated prior to the consistent use of chemotherapy only 12 of 33 patients with hepatocellular carcinoma who had complete excision of the tumor survived.[4] It is probable that adjuvant chemotherapy does benefit children with completely resected hepatocellular carcinoma. Treatment with cisplatin and doxorubicin may be recommended as adjuvant therapy since these are active agents in the treatment of hepatocellular carcinoma. Studies in adults in China suggest that hepatic arterial chemoembolization before surgery may improve the outcome of subsequent hepatectomy.[7] (Refer to the PDQ summary on Adult Primary Liver Cancer Treatment for more information.)


Ortega JA, Krailo MD, Haas JE, et al.: Effective treatment of unresectable or metastatic hepatoblastoma with cisplatin and continuous infusion doxorubicin chemotherapy: a report from the Childrens Cancer Study Group. J Clin Oncol 9 (12): 2167-76, 1991. [PUBMED Abstract]

Douglass EC, Reynolds M, Finegold M, et al.: Cisplatin, vincristine, and fluorouracil therapy for hepatoblastoma: a Pediatric Oncology Group study. J Clin Oncol 11 (1): 96-9, 1993. [PUBMED Abstract]

Pritchard J, Brown J, Shafford E, et al.: Cisplatin, doxorubicin, and delayed surgery for childhood hepatoblastoma: a successful approach--results of the first prospective study of the International Society of Pediatric Oncology. J Clin Oncol 18 (22): 3819-28, 2000.  [PUBMED Abstract]

Exelby PR, Filler RM, Grosfeld JL: Liver tumors in children in the particular reference to hepatoblastoma and hepatocellular carcinoma: American Academy of Pediatrics Surgical Section Survey--1974. J Pediatr Surg 10 (3): 329-37, 1975.  [PUBMED Abstract]

Ortega JA, Douglass EC, Feusner JH, et al.: Randomized comparison of cisplatin/vincristine/fluorouracil and cisplatin/continuous infusion doxorubicin for treatment of pediatric hepatoblastoma: A report from the Children's Cancer Group and the Pediatric Oncology Group. J Clin Oncol 18 (14): 2665-75, 2000.  [PUBMED Abstract]

Katzenstein HM, Krailo MD, Malogolowkin MH, et al.: Hepatocellular carcinoma in children and adolescents: results from the Pediatric Oncology Group and the Children's Cancer Group intergroup study. J Clin Oncol 20 (12): 2789-97, 2002. [PUBMED Abstract]

Zhang Z, Liu Q, He J, et al.: The effect of preoperative transcatheter hepatic arterial chemoembolization on disease-free survival after hepatectomy for hepatocellular carcinoma. Cancer 89 (12): 2606-12, 2000. [PUBMED Abstract]

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