Czerwiński W
Probl Med Wieku Rozwoj. 1984;13:117-33.
Unfavorable prognosis for children with malignant liver tumors, is caused not only because of late diagnosis in this children, but because of imperfet methods of treatment. These methods taken from adults oncology have to be adapted for pediatric patients in front of their differences in biology, pharmacodynamic reactivity and tumor-host relationships in developing organism. Some methods of treatment can be done the same way as in adults, but another (intraarterial treatment) can be used in children with much better results then in adults. Primary malignant tumors in children are hepatoblastoma and hepatocelullar carcinoma (minority) and metastatic tumors are nephroblastoma or neuroblastoma. That makes probably basic difference with liver tumors in adults, as well as absence of hepatic cirrhosis in children. 42 children with primary and metastatic liver tumors were treated by the author in Clinical Department of Pediatric Oncology, Institute of Mother and Child, Warsaw. 19 of them was given intra-arterial chemotherapy for unoperable primary tumors, 6--systemic chemotherapy for the same reason, 5--radiotherapy (all of them neuroblastomas) and 15 was submited to surgery-From this group 13 was operated radicaly by means of right extended or left lobectomy. Only in one case, middle lobectomy was done. 3 children operated radicaly was previously treated with intra-arterial chemotherapy and only after significant remission, surgery was done. As a result 6 children is RFS for more than 3 years. One of them exclusively grace to intra-arterial treatment. Experimental investigation done in monkeys shown no long term morphological and/or functional disturbances after long time hepatic infusion with chemotherapeutic drugs. In conclusion it is to state that surgery is the best method of treatment in primary liver tumors, some time preceded with intra-aterial chemotherapy that is safe for normal liver tissue. In metastatic neuroblastoma in liver, radiotherapy with systemic chemotherapy can give 60% of RFS (recurrent free survival).
恶性肝肿瘤患儿预后不佳，不仅是因为这些患儿诊断较晚，还因为治疗方法不完善。从成人肿瘤学借鉴的这些方法，必须根据发育中的机体在生物学、药效学反应性以及肿瘤与宿主关系方面的差异，对儿科患者进行调整。有些治疗方法在儿童中可以与成人相同，但另一些方法（动脉内治疗）在儿童中的效果比在成人中要好得多。儿童原发性恶性肿瘤是肝母细胞瘤和肝细胞癌（少数），转移性肿瘤是肾母细胞瘤或神经母细胞瘤。这可能与成人肝肿瘤有根本区别，儿童也不存在肝硬化。作者在华沙母婴研究所儿科肿瘤临床科室治疗了42例原发性和转移性肝肿瘤患儿。其中19例因原发性肿瘤无法手术而接受动脉内化疗，6例因同样原因接受全身化疗，5例接受放疗（均为神经母细胞瘤），15例接受手术——该组中有13例通过右叶扩大切除术或左叶切除术进行了根治性手术。仅1例进行了中叶切除术。3例接受根治性手术的患儿此前接受了动脉内化疗，仅在明显缓解后才进行手术。结果6例患儿无复发生存期超过3年。其中1例完全得益于动脉内治疗。在猴子身上进行的实验研究表明，长时间肝内输注化疗药物后，未出现长期的形态学和/或功能障碍。总之，可以说手术是原发性肝肿瘤的最佳治疗方法，有时术前进行对正常肝组织安全的动脉内化疗。在肝转移性神经母细胞瘤中，放疗联合全身化疗可使60%的患儿获得无复发生存期。
