Meyers Rebecka L, Tiao Greg M, Dunn Stephen P, Langham Max R
University of Utah, Primary Children's Medical Center, Salt Lake City, UT 84113, USA.
Front Biosci (Elite Ed). 2012 Jan 1;4(4):1293-302. doi: 10.2741/e460.
Complete surgical resection is essential to long-term survival in children with hepatoblastoma. We present the guidelines from the Children's Oncology Group (COG), liver tumor study group of the Societe Internationale Oncologie Pediatrique (SIOPEL), and German Pediatric Oncology Group (GPOH) for early referral of children with potentially unresectable hepatoblastoma to a specialty center with expertise in extreme resection and liver transplantation. Patients who will become candidates for liver transplantation should receive chemotherapy following the same protocols as for children undergoing a partial hepatectomy. The Pediatric Liver Unresectable Tumor Observatory (PLUTO) is an international prospective database established to collect data and make future recommendations on controversial issues regarding the use of transplant in hepatoblastoma including: 1) What is the optimal treatment of multifocal tumors. 2) What is the role of extreme resection vs. liver transplant in patients with major venous involvement. 3) What is the role of transplant in patients who present with lung metastasis. 3) Should patients with tumor relapse be offered a rescue transplant. 4) What is the role of pre- and post- transplant chemotherapy.
完整的手术切除对于肝母细胞瘤患儿的长期生存至关重要。我们介绍了儿童肿瘤学组（COG）、国际小儿肿瘤学会（SIOPEL）肝肿瘤研究组以及德国小儿肿瘤学组（GPOH）的指南，内容是关于将可能无法切除的肝母细胞瘤患儿尽早转诊至在极限切除和肝移植方面具有专业知识的专科中心。将成为肝移植候选者的患者应按照与接受部分肝切除术的儿童相同的方案接受化疗。小儿肝脏不可切除肿瘤观察站（PLUTO）是一个国际前瞻性数据库，其建立目的是收集数据并就肝母细胞瘤移植应用方面的争议问题提出未来建议，这些问题包括：1）多灶性肿瘤的最佳治疗方法是什么。2）在主要静脉受累的患者中，极限切除与肝移植相比各自的作用是什么。3）肺转移患者中移植的作用是什么。3）肿瘤复发的患者是否应接受挽救性移植。4）移植前和移植后化疗的作用是什么。
