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Hepatoblastoma, a form of liver cancer in children is best treated with intensive chemotherapy followed by surgery, said recent results from Dutch-3HR SIOPEL study. Article posted April 27, 2010

April 27, 2010: Source: J Clin Oncol. 2010 in April 1920.

Treatment with a dose-intensive chemotherapy and after surgery improves survival in patients with high-risk hepatoblastoma, according to the results of the study SIOPEL-3HR.

In the original SIOPEL study, all patients received preoperative chemotherapy (PLADO, cisplatin plus doxorubicin) and only then an operation, which was a better overall and disease-free survival as compared with previous study results. However, the prognosis is still unsatisfactory in children with tumors where all four compartments of the liver metastases contain.

In the latest study examined Dr. Jozsef Zsiros and colleagues at the University of Amsterdam, the efficacy of a new intensive preoperative chemotherapy in children with a high risk hepatoblastoma.

Patients received alternating cycles of cisplatin and carboplatin plus doxorubicin and after tumor resection. Seven cycles were given before surgery and three cycles were given after surgery.

Of the 151 patients enrolled, 118 patients responded (78.7%) with a partial response to chemotherapy. Among the 69 patients with initial pulmonary metastases, it reached 36 (52.2%) a complete remission with chemotherapy alone.

Complete resection of the liver was achieved in 115 patients (76.2%) by either partial hepatectomy (n = 84) or liver (n = 31). In 106 patients (70.2%) was a complete removal of all tumors (including metastases) stage.

onmouseover = "this.style.backgroundColor = '# ebeff9'" onmouseout = "this.style.backgroundColor = '# fff'"> The liver tumor was removed by surgery in 31 of the 74 patients with a pretext zogeheren IV tumor. Yet 26 of these patients underwent a liver transplant, resulting in a complete removal of all tumors of 77.0% for this group.

The 3 year disease-free survival and overall survival for the whole group was 65% and 69%, respectively. For patients with a pretext IV tumor and those with metastasis, disease-free survival was 68% and 56%, respectively, and overall survival was 69% and 62%, respectively.

The SIOPEL group is currently investigating the efficacy of treatment with high dose cisplatin intensity in a high-risk patients and the efficacy of irinotecan in patients with recurrent disease. "This approach would be a part of future therapeutic strategies against advanced hepatoblastoma may be, "say the researchers.

J Clin Oncol. 2010 in April 1920. [Epub ahead of print]

Successful Treatment of Childhood hepatoblastoma Risk With High-Dose-Intensive Multiagent Chemotherapy and Surgery: Final Results of the Study SIOPEL-3HR.

Zsíros J , Maibach R , Shafford E , Brugieres L , Brock P , Czauderna P , Roebuck D , Childs M , Zimmermann A , Lait Here V , Otte JB , de Camargo B , MacKinlay G , Scopinaro M , Aronson D , Plaschkes J , Perilongo G .

Departments of Pediatric Oncology and of Pediatric Surgery, Emma Children's Hospital / Academic Medical Centre, Amsterdam, the Netherlands, International Breast Cancer Study Group, Coordinating Center, and Department of Surgical Pathology, Institute of Pathology, and Department of Surgery, University Children's Hospital, Bern, Switzerland; Children's Cancer and Leukaemia Group (CCLG), Data Centre, Leicester, and Departments of Haematology and Oncology and of Radiology, Great Ormond St Hospital for Children, London, and Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh , United Kingdom, Department of Pediatrics, Institut Gustave Roussy, Villejuif Cedex, and Department of Pediatric Hemato-Oncology, Centre Hospitalier Universitaire, Besancon, France, Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland, Department of Pediatric Surgery, Université Catholique de Louvain, Saint Luc University Clinics, Brussels, Belgium, Department of Research, Hospital do Cancer, Sao Paolo, Brazil, Department of Hemato-Oncology, Hospital Prof. Dr. JP Garrahan, Buenos Aires, Argentina; and Division of Hematology-Oncology, Department of Pediatrics, University Hospital of Padua, Padua, Italy.

Abstract

PURPOSE: The primary was objectifying to determining the efficacy of a newly designed Preoperative chemotherapy regimen in an Attempt to Improve the cure rate of children with high-risk hepatoblastoma.

PATIENT AND METHODS: High risk was defined as follows: tumor in all liver sections (ie, Pretreatment Extension IV [pretext IV]), or vascular invasion (portal vein [P +], three hepatic veins [V +]), or intra- extrahepatic abdominal extension (E +), or meta-static disease, or alpha-fetoprotein Less than 100 ng / mL at diagnosis. Patients Were Treated with alternating cycles of cisplatin and carboplatin plus doxorubicin (preoperatively, n = 7, postoperatively, n = 3) and delayed tumor resection.

RESULTS: Of the 151 patients (150 evaluable for response) 118 (78.7%) Achieved a partial response to chemotherapy. Complete resection of the liver tumor Could Be Achieved in 115 patients (76.2%) Either by partial hepatectomy (55.6%) or by liver transplantation (20.6%). In 106 children (70.2%), complete resection of all tumor lesions (include metastases) was Achieved. Among the initial Patients with lung metastases, 52.2% Achieved complete remission of the lung lesions with chemotherapy alone. In half of the initial pretext Patients with tumor-IV as the only high-risk feature, Could Be Completely resected the tumor with partial hepatectomy. Event-free survival (EFS) and overall survival (OS) estimates at 3 years Were 65% (95% CI, 57% to 73%) and 69% (95% CI, 62% to 77%) for the whole group. EFS and OS for ALL patients with tumor-IV pretext Were 68% and 69%, respectively, and They Were 56% and 62%, respectively, for Patient with metastasis.

CONCLUSION: The Applied treatment rendered a great proportioning or resectable tumors, and in comparison with Previously published results, led to an improved survival in patient with high-risk hepatoblastoma.

PMID: 20406943 [PubMed - as supp song by publisher]