Oue T, Fukuzawa M, Kusafuka T, Kohmoto Y, Okada A, Imura K
Department of Pediatric Surgery, Osaka University Medical School and Osaka Medical Center and Research Institute for Maternal and Child Health, Japan.
J Pediatr Surg. 1998 Dec;33(12):1771-5. doi: 10.1016/s0022-3468(98)90282-2.
The prognosis of hepatoblastoma is poor unless the tumor is completely resected. Various types of chemotherapy have been developed to increase its resectability. Recently, transcatheter arterial chemoembolization (TACE) has been developed for the treatment of unresectable adult hepatoma with favorable results. The authors applied this procedure to hepatoblastoma in infants and children.
TACE was performed in eight hepatoblastoma cases. After an intraarterial catheter was inserted into the main feeding artery of the tumor, injection of adriamycin or THP-adriamycin (20 to 30 mg/m2) dispersed in lipiodol and cisplatin (40 to 60 mg/m2) followed by embolization using Gelfoam pieces was performed. Effects of TACE were evaluated according to shrinkage of tumor mass on imaging examinations, alpha-fetoprotein (AFP) levels, and pathological findings of the surgical specimens 4 weeks after TACE.
A marked reduction in tumor size associated with a decrease in AFP level occurred 1 month after the treatment. Tumor shrinkage ranged from 0.9% to 45.0% with a mean value of 25.8%. AFP levels decreased by 0.2% to 11.9% with a mean level of 4.6% from initial levels. In addition, there was no marked chemotherapeutic agent-induced toxicity noted during the observation period. Resection of the tumors was performed safely after TACE in all cases. Pathological examination showed massive necrosis in the surgical specimens, and the mean percentage of necrotic area within the tumor was 71.1%. Two patients died of extensive lung metastasis 2 months and 3 years after the operation, respectively. The remaining six were doing well and free of disease at a mean follow-up period of 50 months.
TACE is an effective, safe, and useful method for the initial treatment of hepatoblastoma.
除非肿瘤完全切除，肝母细胞瘤的预后很差。已开发出各种类型的化疗方法以提高其可切除性。最近，经导管动脉化疗栓塞术（TACE）已被用于治疗不可切除的成人肝癌，并取得了良好的效果。作者将此方法应用于婴幼儿肝母细胞瘤。
对8例肝母细胞瘤患者进行了TACE治疗。在将动脉内导管插入肿瘤的主要供血动脉后，注射分散在碘油中的阿霉素或吡柔比星（20至30mg/m²）和顺铂（40至60mg/m²），随后使用明胶海绵碎片进行栓塞。根据TACE术后4周影像学检查中肿瘤体积的缩小、甲胎蛋白（AFP）水平以及手术标本的病理结果评估TACE的效果。
治疗1个月后肿瘤大小显著减小，同时AFP水平降低。肿瘤缩小范围为0.9%至45.0%，平均值为25.8%。AFP水平从初始水平下降了0.2%至11.9%，平均下降水平为4.6%。此外，在观察期内未发现明显的化疗药物诱导毒性。所有病例在TACE后均安全地进行了肿瘤切除。病理检查显示手术标本中有大量坏死，肿瘤内坏死区域的平均百分比为71.1%。两名患者分别在术后2个月和3年死于广泛肺转移。其余6例在平均50个月的随访期内情况良好，无疾病复发。
TACE是肝母细胞瘤初始治疗的一种有效、安全且有用的方法。
