Li Jia-ping, Chu Jian-ping, Yang Jian-yong, Chen Wei, Wang Yu, Huang Yong-hui
Department of Interventional Radiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Cardiovasc Intervent Radiol. 2008 Nov-Dec;31(6):1117-23. doi: 10.1007/s00270-008-9373-x. Epub 2008 Jun 17.
The purpose of this study was to evaluate the clinical feasibility and efficacy of transcatheter selective arterial chemoembolization (TACE) for unresectable hepatoblastoma in infants and children. The study was performed with the approval of our institutional review board. Sixteen patients (13 boys, 3 girls) with unresectable hepatoblastoma were treated one to three times with preoperative TACE in an effort to improve the surgical and clinical outcome. Their ages ranged from 50 days to 60 months, with a mean age of 20.4 months. All cases were pathologically proved hepatoblastoma by fine-needle biopsy. After an intra-arterial catheter was selectively inserted into the main feeding artery of the tumor, cycles of cisplatin (40 to 50 mg/m(2)) and adriamycin (20 to 30 mg/m(2)) mixed with lipiodol were given, followed by gelatin foam particles or stainless-steel coils. Tumor response was evaluated according to tumor shrinkage, alpha-fetoprotein (AFP) levels, and pathological findings. TACE procedure was performed one to three times, depending on the patient's response. Surgical resection was carried out when the tumor volume appeared sufficiently reduced to allow safe resection by either lobectomy or extended lobectomy. A marked reduction in tumor size associated with decreased AFP level occurred after treatment. According to paired-samples test, tumor shrinkage ranged from 19.0% to 82.0%, with a mean value of 59.2%. AFP levels decreased 99.0% to 29.0% from initial levels, with a mean decrease of 60.0%. TACE allowed subsequent complete surgical resection in 13 cases and the other 3 cases underwent partial resection. One patient underwent successful orthotopic liver transplantation after receiving TACE therapy. Pathological examination showed that the mean percentage of necrotic area in the surgical specimens was 87%. Overall survival rate at 1, 3, and 5 years was 87.5%, 68.7%, and 50%, respectively. Correspondingly, event-free survival rate was 75%, 62.5%, and 43.7%, respectively. In addition, there was no marked chemotherapeutic agent-induced toxicity noted during the observation period. We conclude that TACE is feasible, well tolerated, and effective in inducing surgical resectability of hepatoblastoma in pediatric patients, which has become an independent palliative or curative therapeutic option, especially for patients without distant metastasis.
本研究的目的是评估经导管选择性动脉化疗栓塞术（TACE）治疗婴幼儿及儿童不可切除型肝母细胞瘤的临床可行性及疗效。本研究经我院机构审查委员会批准后开展。16例不可切除型肝母细胞瘤患者（13例男孩，3例女孩）接受了1至3次术前TACE治疗，以改善手术及临床结局。他们的年龄从50天至60个月不等，平均年龄为20.4个月。所有病例均经细针穿刺活检病理证实为肝母细胞瘤。在将动脉内导管选择性插入肿瘤的主要供血动脉后，给予顺铂（40至50mg/m²）和阿霉素（20至30mg/m²）与碘油混合的周期治疗，随后注入明胶海绵颗粒或不锈钢圈。根据肿瘤缩小情况、甲胎蛋白（AFP）水平及病理结果评估肿瘤反应。根据患者反应，TACE手术进行1至3次。当肿瘤体积明显缩小至可通过叶切除术或扩大叶切除术安全切除时，进行手术切除。治疗后肿瘤大小显著减小，AFP水平降低。根据配对样本检验，肿瘤缩小范围为19.0%至82.0%，平均值为59.2%。AFP水平较初始水平下降了99.0%至29.0%，平均下降60.0%。TACE使13例患者随后得以完整手术切除，另外3例患者接受了部分切除。1例患者在接受TACE治疗后成功进行了原位肝移植。病理检查显示手术标本中坏死区域的平均百分比为87%。1年、3年和5年的总生存率分别为87.5%、68.7%和50%。相应地，无事件生存率分别为75%、62.5%和43.7%。此外，在观察期内未发现明显的化疗药物诱导毒性。我们得出结论，TACE在诱导小儿肝母细胞瘤手术可切除性方面是可行的、耐受性良好且有效的，已成为一种独立的姑息或治愈性治疗选择，尤其是对于无远处转移的患者。
