Lungren Matthew P, Towbin Alexander J, Roebuck Derek J, Monroe Eric J, Gill Anne E, Thakor Avnesh, Towbin Richard B, Cahill Anne Marie, Matthew Hawkins C
Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Road Room 1862, Stanford, CA, 94305-5913, USA.
Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Pediatr Radiol. 2018 Apr;48(4):555-564. doi: 10.1007/s00247-018-4068-1. Epub 2018 Jan 23.
Primary liver malignancies are rare in children. Hepatoblastoma and hepatocellular carcinoma (HCC) together represent the overwhelming majority of cases. Overall survival of hepatoblastoma approaches 80% with multimodal treatment approaches that include chemotherapy, surgery and transplantation. However, there remains a subset of children with hepatoblastoma in whom resection or transplantation is not possible. The 5-year survival for children diagnosed with HCC is less than 30% and remains a significant therapeutic challenge. The poor outcomes for children with primary liver tumors motivate investigation of new therapeutic alternatives. Interventional oncology offers a broad scope of percutaneous and transcatheter endovascular cancer therapies that might provide clinical benefits. Minimally invasive approaches are distinct from medical, surgical and radiation oncologic treatments, and in adults these approaches have been established as the fourth pillar of cancer care. Transarterial chemoembolization is a minimally invasive locoregional treatment option performed by interventional radiologists with level-I evidence as standard of care in adults with advanced liver malignancy; transarterial chemoembolization in adults has served to prolong disease-free progression, downstage and bridge patients for surgical and transplant interventions, and improve overall survival. However, while several groups have reported that transarterial chemoembolization is feasible in children, the published experience is limited primarily to small retrospective case series. The lack of prospective trial evidence has in part limited the utilization of transarterial chemoembolization in the pediatric patient population. The purpose of this article is to provide an overview of the role of interventional radiology in the diagnosis and endovascular management of hepatic malignancies in children.
原发性肝恶性肿瘤在儿童中较为罕见。肝母细胞瘤和肝细胞癌（HCC）共同构成了绝大多数病例。采用包括化疗、手术和移植在内的多模式治疗方法，肝母细胞瘤的总体生存率接近80%。然而，仍有一部分肝母细胞瘤患儿无法进行切除或移植手术。被诊断为HCC的儿童5年生存率低于30%，仍然是一个重大的治疗挑战。原发性肝肿瘤患儿的不良预后促使人们研究新的治疗选择。介入肿瘤学提供了广泛的经皮和经导管血管内癌症治疗方法，可能带来临床益处。微创方法不同于医学、外科和放射肿瘤学治疗，在成人中，这些方法已成为癌症治疗的第四大支柱。经动脉化疗栓塞是一种微创局部治疗选择，由介入放射科医生实施，在晚期肝恶性肿瘤成人患者中，一级证据表明其为标准治疗方法；成人经动脉化疗栓塞可延长无病进展期、降低分期并为手术和移植干预搭桥，从而提高总体生存率。然而，虽然有几个研究小组报告经动脉化疗栓塞在儿童中是可行的，但已发表的经验主要限于小型回顾性病例系列。缺乏前瞻性试验证据在一定程度上限制了经动脉化疗栓塞在儿科患者群体中的应用。本文旨在概述介入放射学在儿童肝恶性肿瘤诊断和血管内治疗中的作用。
