1
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Patel PA, Muñoz FG. Interventional oncology in children: Where are we now? J Med Imaging Radiat Oncol 2024. [PMID: 38874327 DOI: 10.1111/1754-9485.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
Paediatric Interventional Oncology (IO) lags behind adult IO due to a scarcity of specific outcome data. The suboptimal way to evolve this field is relying heavily on adult experiences. The distinct tumour types prevalent in children, such as extracranial germ cell tumours, sarcomas, and neuroblastoma, differ strongly from those found in adults, presenting a completely different biological behaviour. Compounding this challenge, paediatric interventional radiology often employs adapted or off-label techniques, potentially compromising optimal outcomes. This review outlines the present indications for interventional radiology in paediatric cancer, from biopsy to supportive care, including complication management. It emphasises the role of locoregional approaches, and explores the status of common paediatric oncological diseases, highlighting areas where IO has made progress identifying potential opportunities for future advancements in this evolving field.
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Affiliation(s)
- Premal Amrishkumar Patel
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital for Children, London, UK
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Fernando Gómez Muñoz
- Interventional Radiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Interventional Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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2
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Aguado A. Role of Interventional Radiology in Pediatric Cancer Patients. Curr Oncol Rep 2022; 24:1731-1740. [PMID: 36057070 DOI: 10.1007/s11912-022-01320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Pediatric interventional radiology (IR) is a growing subspecialty. Here, we review the current role of IR in children with cancer, which uses imaging such as ultrasound, fluoroscopy, and computed tomography to perform minimally invasive procedures. These include biopsy, needle localization, central venous access, thermal ablation, transarterial chemoembolization, transarterial radioembolization with yttrium-90, non-tunneled/tunneled drainage catheter placement, and lymphatic interventions. RECENT FINDINGS Although locoregional therapies for the treatment of cancer in adults are common, they are less common in children, perhaps due to the relative rarity of cancer in children, their typically better performance status, and paucity of comorbidities. Preliminary results from small-scale studies for ablation, transarterial chemoembolization, and transarterial radioembolization with yttrium-90 used in the front-line armamentarium of curative therapy are encouraging. Pediatric IR offers an array of minimally invasive procedures intended to diagnose and treat pediatric cancer patients. However, more research is required to determine the efficacy of locoregional therapy in children and to define the clinical scenarios where benefit is likely to be optimized.
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Affiliation(s)
- Allison Aguado
- Division of Interventional Radiology, Nemours Children's Health, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
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3
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He M, Cai JB, Lai C, Mao JQ, Xiong JN, Guan ZH, Li LJ, Shu Q, Ying MD, Wang JH. Neoadjuvant transcatheter arterial chemoembolization and systemic chemotherapy for the treatment of undifferentiated embryonal sarcoma of the liver in children. World J Clin Cases 2022; 10:6437-6445. [PMID: 35979288 PMCID: PMC9294901 DOI: 10.12998/wjcc.v10.i19.6437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/23/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Undifferentiated embryonal sarcoma of the liver (UESL) is a rare and aggressive mesenchymal tumor in children. Herein, we describe our experience in neoadjuvant therapy (NAT) and subsequent surgery for the treatment of UESL in children.
AIM To evaluate the efficacy of NAT and explore a new choice for successful operation of UESL in children.
METHODS We retrospectively analyzed six patients newly diagnosed with unresectable UESL who received NAT and then surgery at our center between January 2004 and December 2019. The tumor was considered unresectable if it involved a large part of both lobes of the liver or had invaded the main hepatic vessels or inferior vena cava. The NAT included preoperative transcatheter arterial chemoembolization (TACE) and systemic chemotherapy. The patients were 4 boys and 2 girls with a mean age of 7 years. The longest tumor at presentation ranged from 8.6 to 14.8 cm (mean, 12 cm). Extrahepatic metastases were present in 2 cases. Preoperative systemic chemotherapy was administered 3 wk after TACE. Tumor resection was performed 3 wk after one or two cycles of NAT. The patients received systemic chemotherapy after surgery.
RESULTS All patients successfully underwent NAT and complete resection. The tumor volumes decreased by 18.2%–68.7%, with a mean decrease of 36% after 1 cycle of NAT (t = 3.524, P = 0.017). According to the Response Evaluation Criteria In Solid Tumors criteria, 4 patients had a partial response and underwent surgery, while 2 had stable disease and received another cycle of NAT before surgery. Massive tumor necrosis was seen on pathological examination of the surgical specimen: > 90% necrosis in two, > 50% necrosis in three, and 25% necrosis in 1, with an average of 71.8%. Post-NAT complications included fever, nausea and vomiting, and mild bone marrow suppression. Elevated alanine transaminase levels occurred in all patients, which returned to normal within 7–10 d after treatment. No cardiac or renal toxicity, severe hepatic dysfunction, bleeding and non-target embolization were observed in the patients. The median follow-up period was 8 years with an overall survival of 100%.
CONCLUSION NAT effectively reduced tumor volume, cleared the tumor margin, and caused massive tumor necrosis. This may be a promising choice for successful surgery of UESL in children.
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Affiliation(s)
- Min He
- Department of Surgical Oncology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang Province, China
| | - Jia-Bin Cai
- Department of Surgical Oncology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang Province, China
| | - Can Lai
- Department of Radiology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang Province, China
| | - Jun-Qing Mao
- Department of Surgical Oncology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang Province, China
| | - Jie-Ni Xiong
- Department of Surgical Oncology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang Province, China
| | - Zhong-Hai Guan
- Department of Surgical Oncology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang Province, China
| | - Lin-Jie Li
- Department of Surgical Oncology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang Province, China
| | - Qiang Shu
- Department of Surgical Oncology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang Province, China
| | - Mei-Dan Ying
- Cancer Center, Zhejiang University, Hangzhou 310058, Zhejiang Province, China
| | - Jin-Hu Wang
- Department of Surgical Oncology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang Province, China
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4
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Balli HT, Aikimbaev K, Guney IB, Piskin FC, Yagci-Kupeli B, Kupeli S, Kanmaz T. Trans-Arterial Radioembolization with Yttrium-90 of Unresectable and Systemic Chemotherapy Resistant Hepatoblastoma in Three Toddlers. Cardiovasc Intervent Radiol 2022; 45:344-348. [PMID: 35034139 DOI: 10.1007/s00270-021-03026-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023]
Abstract
The aim of this short communication was to report the results of transarterial radioembolization (TARE) with Yttrium-90 (Y90) loaded resin microspheres in three toddlers with unresectable and systemic chemotherapy-resistant HB hepatoblastoma (HB). Six TARE procedures were performed on the patients. The dose required for treatment was calculated using partition model. Administered doses of Y90 were 1.369, 0.851, and 1.147 GBq. Complete radiological response in two patients and partial response enabling liver resection in one patient were achieved. Neither life-threatening nor minor complications developed after the treatment. These results demonstrates that HB is a radiosensitive neoplasm, and TARE-Y90 can be used as the primary, neoadjuvant and palliative treatment method in patients with unresectable and systemic chemotherapy-resistant HBs. However, studies with higher number of patients and long-term results are required.
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Affiliation(s)
- Huseyin Tugsan Balli
- Department of Radiology, Cukurova University Medical School, Balcali Hospital, Adana, Turkey
| | - Kairgeldy Aikimbaev
- Department of Radiology, Cukurova University Medical School, Balcali Hospital, Adana, Turkey
| | - Isa Burak Guney
- Department of Nuclear Medicine, Cukurova University Medical School, Balcali Hospital, Adana, Turkey
| | - Ferhat Can Piskin
- Department of Radiology, Cukurova University Medical School, Balcali Hospital, Adana, Turkey.
| | - Begul Yagci-Kupeli
- Department of Pediatric Hematology and Oncology, University of Health Sciences, Adana Education and Research Center, Adana, Turkey
| | - Serhan Kupeli
- Department of Pediatric Oncology, Cukurova University Medical School, Balcali Hospital, Adana, Turkey
| | - Turan Kanmaz
- Department of Pediatric Surgery, Organ Transplantation Center, Koc University Hospital, Istanbul, Turkey
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5
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Yağcı-Küpeli B, Ballı T. Hepatoblastoma treated successfully with drug-eluting bead transarterial chemoembolization: Outcome of seven-year follow-up. Pediatr Blood Cancer 2021; 68:e29063. [PMID: 33871930 DOI: 10.1002/pbc.29063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/09/2021] [Accepted: 04/01/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Begül Yağcı-Küpeli
- Adana City Education and Research Hospital, Department of Pediatric Hematology/Oncology, University of Health Sciences, Adana, Turkey
| | - Tuğsan Ballı
- Faculty of Medicine, Çukurova University, Deapartment of Radiology, Adana, Turkey
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6
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Shaikh R, Munoz FG. Endovascular approaches in pediatric interventional oncology. CVIR Endovasc 2021; 4:2. [PMID: 33387076 PMCID: PMC7778666 DOI: 10.1186/s42155-020-00190-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
The demand for interventional oncological (IO) treatment of pediatric cancers is becoming increasingly common, at least at several tertiary care institutions. The data and techniques used in pediatric IO are largely extrapolated from experience in adult patients. The management of pediatric tumors differs from that in adults in several categories, such as, the curative intent of treatment, wide use of general anesthesia, aggressive pain management, potentially longer hospital stay, variation in chemotherapy dosing etc. Additionally, pediatric cancers are managed by protocols directed by national and international oncology groups such as the Children’s Oncology Group (COG). Consequently, the translation and adoption of these techniques is gradual, but there is a noticeable uptrend due to the growing need. This review will update the current endovascular IO treatments for common pediatric liver, renal, bone and soft tissue tumors.
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Affiliation(s)
- Raja Shaikh
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood, Boston, MA-02115, USA.
| | - Fernando Gomez Munoz
- Hospital Clinic-Hospital Sant Joan de Deu, C/ Villarroel 170, Passeig de Sant Joan de Déu, 2, Esplugues del Llobregat, 08950, Barcelona, Spain
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7
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Hoyer M, Goli R, Barnett KK, Raabe EH, Hong K. Treatment of Hepatoblastoma With Drug-eluting Bead Transarterial Chemoembolization in a 13-Month-Old Infant: A Case Report and Review of the Literature. J Pediatr Hematol Oncol 2021; 43:e123-e126. [PMID: 32459718 DOI: 10.1097/mph.0000000000001842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Prior reports have shown the utility of conventional lipiodol-based transarterial chemoembolization in hepatoblastoma. The authors describe the first reported case of hepatoblastoma treated with drug-eluting bead transarterial chemoembolization (DEB-TACE). OBSERVATIONS An 11-month-old infant presented with hepatoblastoma measuring 14.3 cm. A trial of cisplatin chemotherapy followed by sequential DEB-TACE to the tumor's feeding vasculature reduced the mass to 5.3 cm. The patient tolerated both sessions of DEB-TACE without any major complication. Having demonstrated adequate disease control, the patient then underwent successful liver transplantation. CONCLUSION This report provides promising evidence for the treatment of hepatoblastoma with DEB-TACE.
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Affiliation(s)
- Matthew Hoyer
- Department of Radiology and Radiological Science, Division of Interventional Radiology
| | - Rakesh Goli
- Department of Radiology and Radiological Science, Division of Interventional Radiology
| | - Katherine K Barnett
- Department of Oncology, Division of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric H Raabe
- Department of Oncology, Division of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kelvin Hong
- Department of Radiology and Radiological Science, Division of Interventional Radiology
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8
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Angelico R, Grimaldi C, Gazia C, Saffioti MC, Manzia TM, Castellano A, Spada M. How Do Synchronous Lung Metastases Influence the Surgical Management of Children with Hepatoblastoma? An Update and Systematic Review of the Literature. Cancers (Basel) 2019; 11:E1693. [PMID: 31683629 PMCID: PMC6895839 DOI: 10.3390/cancers11111693] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022] Open
Abstract
Approximately 20% of children with hepatoblastoma (HB) have metastatic disease at diagnosis, most frequently in the lungs. In children with HB, lung metastatic disease is associated with poorer prognosis. Its treatment has been approached with a variety of methods that integrate chemotherapy and surgical resection. The timing and feasibility of complete extirpation of lung metastases, by chemotherapy and/or metastasectomy, is crucial for the surgical treatment of the primary liver tumor, which can vary from major hepatic resections to liver transplantation (LT). In children with unresectable HB, which can be surgically treated only by LT, the persistence of unresectable metastases after neoadjuvant chemotherapy excludes the possibility of recurring to LT with consequent negative impact on patients' outcomes. Due to limited evidence and experience, there is no consensus amongst oncologists and surgeons across institutions regarding the surgical treatment for HB with synchronous metastatic lung disease. This narrative review aimed to update the current management of pulmonary metastasis in children with HB and to define its role in the decision-making strategy for the surgical approach to primary liver tumours.
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Affiliation(s)
- Roberta Angelico
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
| | - Chiara Grimaldi
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
| | - Carlo Gazia
- Department of Surgery Science, HPB and Transplantation Unit, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - Maria Cristina Saffioti
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
| | - Tommaso Maria Manzia
- Department of Surgery Science, HPB and Transplantation Unit, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - Aurora Castellano
- Division of Oncohematology, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
| | - Marco Spada
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
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9
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Weiss KE, Sze DY, Rangaswami AA, Esquivel CO, Concepcion W, Lebowitz EA, Kothary N, Lungren MP. Transarterial chemoembolization in children to treat unresectable hepatocellular carcinoma. Pediatr Transplant 2018; 22:e13187. [PMID: 29707868 DOI: 10.1111/petr.13187] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 01/20/2023]
Abstract
Children with unresectable HCC have a dismal prognosis and few approved treatment options. TACE is an effective treatment option for adults with HCC, but experience in children is very limited. Retrospective analysis was performed of 8 patients aged 4-17 years (4 male, mean 12.5 years) who underwent TACE for unresectable HCC. Response to TACE was evaluated by change in AFP, RECIST and tumor volume, PRETEXT, and transplantation eligibility by UCSF and Milan criteria. Post-procedure mean follow-up was 8.2 years. Mean overall change in tumor volume for the 8 patients was 51%. Percent change in AFP ranged from a decrease of 100% to an increase of 89.3%, with a mean change of -49.6%. Two patients did not undergo resection or transplantation and died of progressive disease. Six patients underwent orthotopic liver transplantation with mean first TACE-to-transplant interval of 141 days (range 11-514). Following transplantation, 5 patients were alive at the end of the follow-up period and one died of recurrent disease. Based on our initial experience, TACE for children with unresectable HCC appears to be a safe and effective method for managing hepatic tumor burden and for downstaging and bridging to liver transplantation.
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Affiliation(s)
- Krista E Weiss
- Division of Interventional Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Daniel Y Sze
- Division of Interventional Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Arun A Rangaswami
- Department of Pediatric Oncology, Stanford University Medical Center, Stanford, CA, USA
| | - Carlos O Esquivel
- Department of Pediatric Transplant Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Waldo Concepcion
- Department of Pediatric Transplant Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Edward A Lebowitz
- Division of Interventional Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Nishita Kothary
- Division of Interventional Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Matthew P Lungren
- Division of Interventional Radiology, Stanford University Medical Center, Stanford, CA, USA
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10
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Kohorst MA, Warad DM, Matsumoto JM, Heimbach JK, El-Youssef M, Arndt CAS, Rodriguez V, Nageswara Rao AA. Management of pediatric hepatocellular carcinoma: A multimodal approach. Pediatr Transplant 2017. [PMID: 28631359 DOI: 10.1111/petr.13007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
HCC is rare in the pediatric population, but is the second most common liver malignancy in children. Survival rates for primary unresectable HCC have been dismal. The objective of this study was to describe our experience with a multimodal approach for the management of unresectable HCC in two adolescent patients and to review the literature. Both patients are currently alive with no recurrence at 51 and 29 months post-transplant. Multimodality treatment involving chemotherapy with doxorubicin, cisplatin, and sorafenib; TACE; timely liver transplantation; and post-transplant therapy with sorafenib and mTOR inhibitors may help improve outcomes and prolong survival in pediatric patients with unresectable HCC.
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Affiliation(s)
- Mira A Kohorst
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Mayo Clinic, Rochester, MN, USA
| | - Deepti M Warad
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Mounif El-Youssef
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Gastroenterology, Mayo Clinic, Rochester, MN, USA
| | - Carola A S Arndt
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Mayo Clinic, Rochester, MN, USA
| | - Vilmarie Rodriguez
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Mayo Clinic, Rochester, MN, USA
| | - Amulya A Nageswara Rao
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Mayo Clinic, Rochester, MN, USA
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Abstract
Although rare, hepatoblastoma is the most common pediatric liver tumor. Complete resection is a critical component for cure; however, most patients will have tumors that are not resected at diagnosis. For these patients, administration of neoadjuvant chemotherapy renders tumors resectable in most patients. For patients whose tumors remain unresectable after chemotherapy, liver transplantation is indicated (in the absence of active unresectable metastatic disease). In patients whose tumors remain unresectable after conventional chemotherapy, interventional techniques may serve as a promising option to reduce tumor size, decrease systemic toxicity, decrease need for liver transplantation, and increase feasibility of tumor resection.
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Affiliation(s)
- Angela D Trobaugh-Lotrario
- Department of Pediatric Hematology and Oncology, Providence Sacred Heart Children's Hospital, Spokane, WA
| | - Rebecka L Meyers
- Primary Children's Hospital, University of Utah, Salt Lake City, UT
| | | | - James H Feusner
- Children's Hospital & Research Center Oakland, Oakland, CA, USA
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12
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Imaging of Rare Primary Malignant Hepatic Tumors in Adults With Histopathological Correlation. J Comput Assist Tomogr 2017; 40:452-62. [PMID: 26938690 DOI: 10.1097/rct.0000000000000382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma and cholangiocarcinoma are the most common primary liver malignancies in adults (comprising >85%); however, liver is also host to some unusual primary malignant tumors. Some of these tumors show distinct demographic, clinicopathologic, and imaging features. Imaging features of these uncommon primary malignant liver tumors are presented with an attempt to correlate them with histopathology.
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13
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Inserra A, Narciso A, Paolantonio G, Messina R, Crocoli A. Palliative care and pediatric surgical oncology. Semin Pediatr Surg 2016; 25:323-332. [PMID: 27955737 DOI: 10.1053/j.sempedsurg.2016.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Survival rate for childhood cancer has increased in recent years, reaching as high as 70% in developed countries compared with 54% for all cancers diagnosed in the 1980s. In the remaining 30%, progression or metastatic disease leads to death and in this framework palliative care has an outstanding role though not well settled in all its facets. In this landscape, surgery has a supportive actor role integrated with other welfare aspects from which are not severable. The definition of surgical palliation has moved from the ancient definition of noncurative surgery to a group of practices performed not to cure but to alleviate an organ dysfunction offering the best quality of life possible in all the aspects of life (pain, dysfunctions, caregivers, psychosocial, etc.). To emphasize this aspect a more modern definition has been introduced: palliative therapy in whose context is comprised not only the care assistance but also the plans of care since the onset of illness, teaching the matter to surgeons in training and share paths. Literature is very poor regarding surgical aspects specifically dedicated and all researches (PubMed, Google Scholar, and Cochrane) with various meshing terms result in a more oncologic and psychosocial effort.
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Affiliation(s)
- Alessandro Inserra
- General Pediatric and Thoracic Surgery, Bambino Gesù Children׳s Hospital-Research Institute, Rome, Italy.
| | - Alessandra Narciso
- General Pediatric and Thoracic Surgery, Bambino Gesù Children׳s Hospital-Research Institute, Rome, Italy
| | - Guglielmo Paolantonio
- Interventional Radiology Unit, Bambino Gesù Children׳s Hospital-Research Institute, Rome, Italy
| | - Raffaella Messina
- Neurosurgery Unit, Bambino Gesù Children׳s Hospital-Research Institute, Rome, Italy
| | - Alessandro Crocoli
- General Pediatric and Thoracic Surgery, Bambino Gesù Children׳s Hospital-Research Institute, Rome, Italy
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14
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Daldrup-Link HE, Sammet C, Hernanz-Schulman M, Barsness KA, Cahill AM, Chung E, Doria AS, Darge K, Krishnamurthy R, Lungren MP, Moore S, Olivieri L, Panigrahy A, Towbin AJ, Trout A, Voss S. White Paper on P4 Concepts for Pediatric Imaging. J Am Coll Radiol 2016; 13:590-597.e2. [PMID: 26850380 PMCID: PMC4860067 DOI: 10.1016/j.jacr.2015.10.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 12/21/2022]
Abstract
Over the past decade, innovations in the field of pediatric imaging have been based largely on single-center and retrospective studies, which provided limited advances for the benefit of pediatric patients. To identify opportunities for potential "quantum-leap" progress in the field of pediatric imaging, the ACR-Pediatric Imaging Research (PIR) Committee has identified high-impact research directions related to the P4 concept of predictive, preventive, personalized, and participatory diagnosis and intervention. Input from 237 members of the Society for Pediatric Radiology was clustered around 10 priority areas, which are discussed in this article. Needs within each priority area have been analyzed in detail by ACR-PIR experts on these topics. By facilitating work in these priority areas, we hope to revolutionize the care of children by shifting our efforts from unilateral reaction to clinical symptoms, to interactive maintenance of child health.
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Affiliation(s)
- Heike E Daldrup-Link
- Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, California.
| | - Christina Sammet
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | | | - Ellen Chung
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Kassa Darge
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Matthew P Lungren
- Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, California
| | - Sheila Moore
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Andrew Trout
- Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Stephan Voss
- Children's Hospital of Boston, Boston, Massachusetts
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15
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Tan X, Zhang J, Wen Z, Zou Y, Shen G, Zhou S, Li H, Jiang H. Preoperative Transcatheter Arterial Chemoembolization of Hepatoblastoma in Infants. J Vasc Interv Radiol 2014; 25:1029-35. [DOI: 10.1016/j.jvir.2014.03.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/22/2014] [Accepted: 03/29/2014] [Indexed: 01/26/2023] Open
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16
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Efficacy of preoperative transcatheter arterial chemoembolization combined with systemic chemotherapy for treatment of unresectable hepatoblastoma in children. Jpn J Radiol 2014; 32:529-36. [DOI: 10.1007/s11604-014-0340-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/03/2014] [Indexed: 11/24/2022]
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17
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Zhang J, Xu F, Chen K, Zhou S, Li H, Niu C, Tan X. An effective approach for treating unresectable hepatoblastoma in infants and children: Pre-operative transcatheter arterial chemoembolization. Oncol Lett 2013; 6:850-854. [PMID: 24137424 PMCID: PMC3789048 DOI: 10.3892/ol.2013.1444] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 06/21/2013] [Indexed: 12/13/2022] Open
Abstract
The objective of the present study was to investigate the feasibility and efficacy of pre-operative transcatheter arterial chemoembolization (TACE) for unresectable hepatoblastoma in infants and children. A total of 24 patients (14 males and 10 females) with unresectable hepatoblastoma, aged between 26 days and 41 months, were treated with pre-operative TACE between March 2007 and March 2011. All cases were confirmed by computed tomography (CT) and liver tumor biopsy prior to TACE. Arteriography was performed and the chemoembolization mixture (pirarubicin and cisplatin emulsified in lipiodol) was injected, followed by polyvinyl alcohol (PVA). The procedure was performed one to four times depending on the patient's response. There was a significant reduction in tumor volume associated with decreased α-fetoprotein (AFP) levels following TACE. Tumor volumes decreased by between 46.1 and 90.2%, with a mean value of 72%. The AFP levels fell by between 63.8 and 99.9%, with a mean value of 95.7%. A total of 22 cases underwent subsequent safe complete surgical resection and the remaining two patients accepted a partial resection. To evaluate the toxicity of TACE, the alanine aminotransferase (ALT), serum creatinine (Cr) and creatine kinase (CK) levels of the patients were measured to assess liver, renal and cardiac function, respectively. The results showed that no marked chemotherapeutic agent-induced toxicity occurred during TACE. It may be concluded that TACE is an effective and feasible pre-operative therapeutic approach for treating unresectable hepatoblastoma and that it may improve the resectability of bulky liver tumors.
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Affiliation(s)
- Jing Zhang
- Department of Interventional Radiology and Vacular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou Children's Hospital, Guangzhou, Guangdong 510623, P.R. China
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18
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Meyers RL, Czauderna P, Otte JB. Surgical treatment of hepatoblastoma. Pediatr Blood Cancer 2012; 59:800-8. [PMID: 22887704 DOI: 10.1002/pbc.24220] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/08/2012] [Indexed: 11/10/2022]
Abstract
Surgical resection remains the cornerstone of cure in hepatoblastoma (HB). Meticulous review of contrast enhanced CT/MR imaging facilitates PRETEXT and POST-TEXT grouping to determine optimal timing and desired extent of liver resection. Excellent knowledge of liver anatomy is essential and the dissection must ensure protection of the vascular inflow and outflow to the remaining liver at all times. Referral to a liver specialty center in advanced cases may facilitate resectability. Potential surgical complications include bleeding, vascular injury, cardiac arrest, liver failure, and bile leak. The risk of complications can be minimized with preoperative planning, appropriate referral, and precise surgical technique.
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Affiliation(s)
- Rebecka L Meyers
- Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah 84113, USA.
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19
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Rare hepatic malignant tumors: dynamic CT, MRI, and clinicopathologic features: with analysis of 54 cases and review of the literature. ACTA ACUST UNITED AC 2012; 38:511-26. [DOI: 10.1007/s00261-012-9918-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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20
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Rougemont AL, McLin VA, Toso C, Wildhaber BE. Adult hepatoblastoma: learning from children. J Hepatol 2012; 56:1392-403. [PMID: 22326463 DOI: 10.1016/j.jhep.2011.10.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 10/17/2011] [Accepted: 10/17/2011] [Indexed: 01/16/2023]
Abstract
Hepatoblastoma is the most common malignant liver tumour in infants and young children. Its occurrence in the adult population is debated and has been questioned. The aim of this paper is to review the histological and clinical features of adult hepatoblastoma as described in the adult literature, and to compare the findings with those of paediatric hepatoblastoma. The developmental and molecular aspects of hepatoblastoma are reviewed and their potential contribution to diagnosis of adult hepatoblastoma discussed. Case reports of adult hepatoblastoma identified by a PubMed search of the English, French, German, Italian, and Spanish literature through March 2011 were reviewed. Forty-five cases of hepatoblastoma were collected. Age at presentation was variable. Survival was uniformly poor, except for the rare patients who presented with the relatively differentiated, foetal type. The common denominator between adult and paediatric cases is the occurrence of embryonal or immature aspect of the tumours. Whether the adult cases of hepatoblastoma represent blastemal tumours, stem cell tumours, or unusual differentiation patterns in otherwise more frequent adult liver tumours remains to be established. Adult tumours labelled as hepatoblastoma are characterised by malignant appearing mesenchymal components. Surgical management is the cornerstone of therapy in children and also appears to confer an improved prognosis in adults. Whether adult hepatoblastoma exists, remains controversial. Indeed, several features described in adult cases are markedly different from hepatoblastoma as it is understood in children, and other differential diagnoses should also be entertained. Nonetheless, hepatoblastoma should be considered in adults presenting with primary liver tumours in the absence of pre-existing liver disease. Adult and paediatric patients with immature hepatoblastoma appear to have worse outcomes, and adults presenting with presumed hepatoblastoma have an overall poorer prognosis than children with hepatoblastoma. In all patients, surgery should be the treatment of choice, neoadjuvant chemotherapy is advisable.
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Affiliation(s)
- Anne-Laure Rougemont
- Division of Clinical Pathology, Geneva University Hospitals, 1211 Geneva 4, Switzerland
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21
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Heran MKS, Burrill J. Vascular pediatric interventional radiology. Can Assoc Radiol J 2012; 63:S59-73. [PMID: 22658372 DOI: 10.1016/j.carj.2011.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 09/20/2011] [Accepted: 12/09/2011] [Indexed: 12/13/2022] Open
Abstract
Interventional radiology procedures are increasingly in demand in both the adult and pediatric populations. Pediatric procedures mirror many of the adult procedures but with increased complexity due to many considerations, notably patient size. This article reviews the various vascular pediatric interventional procedures. The aim is to provide a greater exposure to the possible treatment options for pediatric patients and to facilitate understanding of the success and complications rates related to various interventions.
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Affiliation(s)
- Manraj K S Heran
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.
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22
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Pediatric malignancies: neuroblastoma, Wilm's tumor, hepatoblastoma, rhabdomyosarcoma, and sacroccygeal teratoma. Surg Clin North Am 2012; 92:745-67, x. [PMID: 22595719 DOI: 10.1016/j.suc.2012.03.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Common pediatric malignancies are reviewed: neuroblastoma, Wilms tumor, hepatoblastoma, rhabdomyosarcoma, and sacrococcygeal teratoma. Elements of presentation, diagnosis, staging, treatment, and longterm prognosis are discussed, with particular attention to surgical management.
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Hoffer FA. Interventional oncology: the future. Pediatr Radiol 2011; 41 Suppl 1:S201-6. [PMID: 21523599 DOI: 10.1007/s00247-011-1990-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 01/04/2011] [Accepted: 01/13/2011] [Indexed: 01/03/2023]
Abstract
Interventional radiology techniques to treat oncological disease have already shown value in adults. The adoption and development of interventional oncology (IO) in children have been more limited and challenging. This relates to the approval process for new devices and agents, oncology group protocol limitations and the inherent hesitation of trying new treatments in children. This paper will discuss how new procedures are developed and approved, and the new therapies that will become available to better treat pediatric malignancies. Bringing the benefits of IO to children will require initiative on the part of pediatric diagnostic and interventional radiologists as well as the cooperation of our clinical colleagues.
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Affiliation(s)
- Fredric A Hoffer
- Department of Radiology, University of Washington, 3904 NE Belvoir Place, Seattle, WA 98105, USA.
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Observation of intravascular changes of superabsorbent polymer microsphere (SAP-MS) with monochromatic X-ray imaging. Cardiovasc Intervent Radiol 2010; 33:1016-21. [PMID: 20429004 DOI: 10.1007/s00270-010-9857-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 03/26/2010] [Indexed: 10/19/2022]
Abstract
This study was designed to evaluate the intravascular transformation behavior of superabsorbent polymer microsphere (SAP-MS) in vivo macroscopically by using monochromatic X-ray imaging and to quantitatively compare the expansion rate of SAP-MS among different kinds of mixtures. Fifteen rabbits were used for our study and transcatheter arterial embolization (TAE) was performed for their auricular arteries using monochromatic X-ray imaging. We used three kinds of SAP-MS (particle diameter 100-150 mum) mixture as embolic spherical particles: SAP-MS(H) absorbed with sodium meglumine ioxaglate (Hexabrix 320), SAP-MS(V) absorbed with isosmolar contrast medium (Visipaque 270), and SAP-MS(S) absorbed with 0.9% sodium saline. The initial volume of SAP-MS particles just after TAE and its final volume 10 minutes after TAE in the vessel were measured to calculate the expansion rate (ER) (n = 30). Intravascular behavior of SAP-MS particles was clearly observed in real time at monochromatic X-ray imaging. Averaged initial volumes of SAP-MS (H) (1.24 x 10(7) microm(3)) were significantly smaller (p < 0.001) than those of SAP-MS (V) (5.99 x 10(7) microm(3)) and SAP-MS (S) (5.85 x 10(7) microm(3)). Averaged final volumes of SAP-MS (H) were significantly larger than averaged initial volumes (4.41 x 10(7) microm(3) vs. 1.24 x 10(7) microm(3); p < 0.0001, ER = 3.55). There were no significant difference between averaged final volumes and averaged initial volumes of SAP-MS (V) and SAP-MS (S). SAP-MS (H), which first travels distally, reaches to small arteries, and then expands to adapt to the vessel lumen, is an effective particle as an embolic agent, causing effective embolization.
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Geller JI, Cripe TP. Adenovirus gene therapy for pediatric cancers: shall we gather at the liver? Pediatr Blood Cancer 2009; 53:133-5. [PMID: 19353623 PMCID: PMC2858055 DOI: 10.1002/pbc.22033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Timothy P. Cripe
- Correspondence to: Timothy P. Cripe, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229.
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Finegold MJ, Egler RA, Goss JA, Guillerman RP, Karpen SJ, Krishnamurthy R, O'Mahony CA. Liver tumors: pediatric population. Liver Transpl 2008; 14:1545-56. [PMID: 18975283 DOI: 10.1002/lt.21654] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Liver tumors in childhood are rare and are typically not detected clinically until they reach a large size and often spread within the organ or metastasize. This can make surgical resection problematic, and almost all of them require extirpation for cure. With very effective chemotherapy for hepatoblastoma and to some extent for sarcomas, many cancers can be shrunk to permit partial hepatectomy, but for most hepatocarcinomas, some of the other malignancies, and even some benign proliferations, their location at the hilum and multiplicity of masses in multiple lobes make transplantation the treatment of choice. Major advances in diagnostic imaging, especially enhanced computed tomography and magnetic resonance imaging, permit a preoperative choice of resection versus transplantation to be achieved in almost all instances, and for the remainder, intraoperative ultrasonography can further help to determine the most desirable approach. The outcome is very much better in the case of hepatoblastoma when transplantation is a primary modality rather than following unsuccessful attempts at resection. In this review, transplantation for liver tumors in children is considered from all aspects, including the importance of screening for tumors whenever possible to avoid the need for transplantation.
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