Jiang Yizhou, Zhou Shaoyi, Shen Gang, Jiang Hua, Zhang Jing
Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Jinan University, Guangzhou, P.R. China.
Medicine (Baltimore). 2018 Oct;97(42):e12607. doi: 10.1097/MD.0000000000012607.
The present study is to evaluate the feasibility and efficacy of microwave ablation (MWA) combined with transcatheter arterial chemoembolization (TACE) in the treatment for unresectable hepatoblastoma in infants and children. A total of 17 patients with PRETEXT stage III and IV hepatoblastoma that was unresectable by conventional resection were included in the present study. The patients were treated with TACE, MWA, and chemotherapy. All cases were diagnosed by computed tomography (CT) and liver tumor biopsy before TACE procedure. All patients received 2 courses of TACE and 1 to 2 times of MWA. Finally, several cycles of chemotherapy were arranged. Among the 17 patients, 14 were alive and had normal alpha-fetoprotein (AFP) levels. The other 3 patients died from tumor progression. The follow-up periods ranged from 10 to 68 months. Complete ablation was achieved in the 14 patients (14/17, 82.35%). Most patients were well tolerated during the whole course except for 1 patient with pneumonedema after TACE and another 1 with biloma after MWA. No marked chemotherapeutic agent-induced toxicity occurred. After chemotherapy or TACE, transient blood indicators and symptoms were observed as follows: myelosuppression, abnormal liver function, gross hematuria, fever, and abdominal pain. Transient symptoms after MWA were fever, abdominal pain, and massive gross hematuria. The present study demonstrates that MWA combined with TACE is a safe and effective method for treating unresectable hepatoblastoma in infants and children with controllable side effects.
本研究旨在评估微波消融（MWA）联合经动脉化疗栓塞术（TACE）治疗婴幼儿不可切除肝母细胞瘤的可行性和疗效。本研究共纳入17例术前影像学检查提示为PRETEXT III期和IV期、无法行常规手术切除的肝母细胞瘤患儿。对患儿采用TACE、MWA及化疗进行治疗。所有病例在TACE术前均经计算机断层扫描（CT）及肝脏肿瘤活检确诊。所有患儿均接受2个疗程的TACE及1至2次MWA治疗。最后安排几个周期的化疗。17例患儿中，14例存活且甲胎蛋白（AFP）水平正常。另外3例患儿死于肿瘤进展。随访时间为10至68个月。14例患儿（14/17，82.35%）实现完全消融。除1例TACE术后出现肺水肿及1例MWA术后出现胆汁瘤外，多数患儿在整个治疗过程中耐受性良好。未出现明显的化疗药物诱导的毒性反应。化疗或TACE术后观察到的短暂血液指标及症状如下：骨髓抑制、肝功能异常、肉眼血尿、发热及腹痛。MWA术后的短暂症状为发热、腹痛及大量肉眼血尿。本研究表明，MWA联合TACE是治疗婴幼儿不可切除肝母细胞瘤的一种安全有效的方法，且副作用可控。
