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Tayfun Küpesiz F, Akınel AN, Akbaş H, Sivrice Ç, Tüysüz Kintrup G, Karagüzel G, Melikoğlu M, Gelen MT, Aydınlı B, Küpesiz A, Güler E. Multidisciplinary Management of Pediatric Hepatoblastoma: A 20-Year Single-Center Experience. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2022; 33:1069-1078. [PMID: 36262102 PMCID: PMC9797744 DOI: 10.5152/tjg.2022.21827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hepatoblastoma is rare cancer that responds well to risk-based chemotherapy, and surgical treatment is needed to achieve complete remission and satisfactory survival rates in hepatoblastoma patients. In this study, we evaluated the clinical features and treatment outcomes of pediatric hepatoblastoma patients treated in our clinic. METHODS Eighteen patients with hepatoblastoma who were treated and followed up in our center between June 1999 and June 2020 were analyzed retrospectively. All patients were evaluated by a multidisciplinary team and managed using a risk-based protocol (SIOPEL-1 and SIOPEL-3). RESULTS The patients' mean age at diagnosis was 38.33 ± 52.34 months. Sixteen patients (89%) received neoadjuvant chemotherapy, and 2 patients (11%) who underwent complete mass excision at diagnosis received adjuvant chemotherapy. After neoadjuvant therapy, the tumor was completely resected in 8 patients (45%), while liver transplantation was performed in 6 patients (34%) because complete resection of the tumor was not possible. Two patients died before surgical treatment. One patient relapsed with lung metastasis after salvage chemotherapy. She is alive without disease at 64 months. The mean follow-up time was 59.3 ± 49.8 months; 5-year overall and disease-free survival rates were 88.9% and 80.8%, respectively. The 5-year overall survival rate was 100% for both liver transplant and resected patients, whereas 5-year disease-free survival was lower in transplant patients (75% vs 100%, P < .001). CONCLUSION Multidisciplinary follow-up is especially important for patients who may need liver transplantation. Some patients may benefit from new treatment options such as radiofrequency ablation and cyberknife treatment.
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Affiliation(s)
- Funda Tayfun Küpesiz
- Division of Pediatric Hematology, Oncology and BMT, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ayşe Nur Akınel
- Division of Pediatric Hematology, Oncology and BMT, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Hilal Akbaş
- Department of Hematology-Oncology, Clinic of Pediatrics, Konya City Hospital, Konya, Turkey
| | - Çiğdem Sivrice
- Division of Pediatric Hematology, Oncology and BMT, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Gülen Tüysüz Kintrup
- Division of Pediatric Hematology, Oncology and BMT, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Güngör Karagüzel
- Department of Pediatric Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Mustafa Melikoğlu
- Department of Pediatric Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | | | - Bülent Aydınlı
- Division of Organ Transplantation, Department of General Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Alphan Küpesiz
- Division of Pediatric Hematology, Oncology and BMT, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Elif Güler
- Division of Pediatric Hematology, Oncology and BMT, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey,Corresponding author: Elif Güler, e-mail:
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Joseph N, Rai S, Singhal K, Saha S, Chakraborty D, Badoni G, Revanth T, Lobo FD. Clinico-histopathological Profile of Primary Paediatric Intra-abdominal Tumours: a Multi-hospital-Based Study. Indian J Surg Oncol 2021; 12:517-523. [PMID: 34658579 DOI: 10.1007/s13193-021-01365-x] [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: 08/27/2020] [Accepted: 06/01/2021] [Indexed: 10/21/2022] Open
Abstract
Paediatric cancers are gradually on the rise in India. Its proportion among children aged < 15 years constitutes close to 5% of the total cancer affected population. A high proportion of this constitutes intra-abdominal tumours. This study was done to study the demographic profile, clinical features and management of intra-abdominal tumours among children. Data of all histopathologically confirmed patients aged < 15 years with various primary intra-abdominal tumours diagnosed from 2009 to 2019 were included in this study. The median age of the patients (n = 50) was 3 years (IQR 1.4, 6). The median age at diagnosis of cancer (n = 23) was 2.5 years (IQR 1, 4). Tumours were more common among males (70%). The most common tumour in this study was Wilm's tumour (17 (34%)). Forty-eight (96%) patients had malignant tumours. Fever was present among the majority (27 (54%)) of the patients. The most common anti-cancer drug used for management was Vincristine, used among 23 patients. Remission was more among infants with Wilm's tumour (P = 0.0221) and among patients with Hodgkin's lymphoma (HL) (P = 0.0444). Default with treatment was more among patients with stage 4 malignancy (P = 0.0186). Recovery following treatment was more among patients with germ cell tumour (P = 0.0082). Reasons for default with treatment in the late stages of malignancies need to be identified in future research studies. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-021-01365-x.
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Affiliation(s)
- Nitin Joseph
- Post Graduate Diploma in Family Medicine, Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Sharada Rai
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Kshitiz Singhal
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Sreejita Saha
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Deboshruti Chakraborty
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Gauri Badoni
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Thella Revanth
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Flora D Lobo
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka India
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Shanmugam N, Scott JX, Kumar V, Vij M, Ramachandran P, Narasimhan G, Reddy MS, Kota V, Munirathnam D, Kelgeri C, Sundaram K, Rela M. Multidisciplinary management of hepatoblastoma in children: Experience from a developing country. Pediatr Blood Cancer 2017; 64. [PMID: 27781375 DOI: 10.1002/pbc.26249] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 08/10/2016] [Accepted: 08/15/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Advances in chemotherapy, liver resection techniques, and pediatric liver transplantation have vastly improved survival in children with hepatoblastoma (HB). These are best managed by a multidisciplinary team (MDT) in a setting where all treatment options are available. Until recently, this was difficult to achieve in India. METHODS All children (<16 years) with HB treated in a pediatric liver surgery and transplantation unit between January 2011 and July 2016 were reviewed. Data regarding the clinical presentation, preoperative management, surgical treatment, postoperative course, and outcomes were extracted from a prospectively managed database. RESULTS Thirty children were treated for HB during the study period. Nine children were PRETEXT 4, 7 were PRETEXT 3, 13 were PRETEXT 2, and 1 was PRETEXT 1 (where PRETEXT is pretreatment extension). All children received a neoadjuvant chemotherapy before surgery followed by an adjuvant chemotherapy. Nineteen children had complete resection, while six underwent primary living donor liver transplantation. There were six mortalities including five children who poorly responded to chemotherapy with progressive tumor extension. At a median follow-up of 30 months, two children who underwent resection and one child who underwent liver transplant had disease recurrence. CONCLUSION Improved outcomes can be achieved in children with HB even in countries with limited resources when they are managed by MDTs with expertise in pediatric oncology, liver resection, and liver transplantation.
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Affiliation(s)
- Naresh Shanmugam
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Global Health City, Chennai, Tamil Nadu, India
| | - Julius Xavier Scott
- Department of Pediatric Hematology and Oncology, Global Health City, Chennai, Tamil Nadu, India
| | - Vimal Kumar
- Department of Pediatric Hematology and Oncology, Global Health City, Chennai, Tamil Nadu, India
| | - Mukul Vij
- Department of Histopathology, Global Health City, Chennai, Tamil Nadu, India
| | - Priya Ramachandran
- Institute of Liver Diseases & Transplantation, Global Health City, Chennai, Tamil Nadu, India
| | - Gomathy Narasimhan
- Institute of Liver Diseases & Transplantation, Global Health City, Chennai, Tamil Nadu, India
| | - Mettu Srinivas Reddy
- Institute of Liver Diseases & Transplantation, Global Health City, Chennai, Tamil Nadu, India
| | - Venugopal Kota
- Institute of Liver Diseases & Transplantation, Global Health City, Chennai, Tamil Nadu, India
| | | | - Chayarani Kelgeri
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Global Health City, Chennai, Tamil Nadu, India
| | - Karthick Sundaram
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Global Health City, Chennai, Tamil Nadu, India
| | - Mohamed Rela
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Global Health City, Chennai, Tamil Nadu, India
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Ayllon Teran D, Gómez Beltran O, Ciria Bru R, Mateos González E, Peña Rosa MJ, Luque Molina A, López Cillero P, Briceño Delgado J. Efficacy of neoadjuvant therapy and surgical rescue for locally advanced hepatoblastomas: 10 year single-center experience and literature review. World J Gastroenterol 2014; 20:10137-10143. [PMID: 25110441 PMCID: PMC4123343 DOI: 10.3748/wjg.v20.i29.10137] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/18/2013] [Accepted: 12/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To report our experience with long-term outcomes after multimodal management therapy.
METHODS: An observational retrospective study was performed containing seven patients with hepatoblastoma (Hbl) treated in our institution, a tertiary referral center, from 2003 to 2011. Demographic, preoperative, surgical, and outcome variables were collected. A survival analysis and a review of the current literature related to combination neoadjuvant chemotherapy and surgical resection on Hbl were performed.
RESULTS: The median age at surgery was 14.4 mo, with a male to female ratio of 4:3. Pretext staging at diagnosis was as follows: stage I, 4 cases; stage II, 2 patients; and stage III, 1 case. Mean pretreatment tumor volume was 735 cm3. Five out of seven patients received neoadjuvant chemotherapy according to SIOPEL-3 or SIOPEL-6 protocols. Tumor volume and alpha-fetoprotein levels significantly dropped after neoadjuvant therapy. Surgical procedures performed included hemihepatectomies, segmentectomies and atypical resection. All patients received chemotherapy after surgery. Median postoperative hospital stay was 8 d. All patients were alive and disease-free after a median follow-up period of 23 mo. With regards to the literature review, seventeen articles were found that were related to our search.
CONCLUSION: Our series shows how multimodal management of Hbl, exhaustive control and a meticulous surgical approach leads to almost 100% complete resection with optimal postoperative results.
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Outcomes of hepatoblastoma in the Indian context. Indian Pediatr 2011; 49:307-9. [PMID: 22080621 DOI: 10.1007/s13312-012-0037-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 09/01/2011] [Indexed: 12/11/2022]
Abstract
A comprehensive review and critical appraisal of published and grey literature was undertaken to identify current treatment practices and outcomes of children with hepatoblastoma in India. Eight single-centre studies with 157 patients (range five to 36 patients in each study) were included. Pre-operative chemotherapy (mainly cisplatin and doxorubicin) followed by surgical resection and additional chemotherapy was the usual practice. There was no stratification of treatment by risk group in any of the studies. The median event-free survival ranged from 33-100%. The two main reasons for treatment failure were treatment-related mortality (0-50%) and progression of disease (0-30%).
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