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Childhood Liver Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment of Hepatocellular Carcinoma

Treatment Options for Stages I and II

  • Complete surgical resection of primary tumor followed by chemotherapy.

    In a randomized trial, seven of eight patients with stage I hepatocellular carcinoma survived disease free after adjuvant cisplatin-based chemotherapy.[1] In a survey of childhood liver tumors treated prior to the consistent use of chemotherapy, only 12 of 33 patients with hepatocellular carcinoma who had complete excision of the tumor survived.[2] This suggests that adjuvant chemotherapy may benefit children with completely resected hepatocellular carcinoma. Treatment with cisplatin and doxorubicin may be recommended as adjuvant therapy since these are active agents in the treatment of hepatocellular carcinoma.[3] Despite improvements in surgical techniques, chemotherapy delivery, and patient supportive care in the past 20 years, clinical trials of cancer chemotherapy for hepatocellular carcinoma have not shown improved outcome.[3]

  • Chemotherapy followed by complete surgical resection of primary tumor.[3]
  • An alternative treatment approach might be transarterial chemoembolization followed by complete surgical resection of primary tumor.

    Studies in adults in China suggest that repeated hepatic transarterial chemoembolization before surgery may improve the outcome of subsequent hepatectomy.[4] (Refer to the PDQ summary on Adult Primary Liver Cancer Treatment for more information.)

Treatment Options for Stage III

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  • Chemotherapy followed by reassessment of surgical resectability followed by complete surgical resection of primary tumor.

    The use of neoadjuvant chemotherapy followed by complete gross surgical resection of the primary tumor is necessary for cure.

  • Chemotherapy followed by reassessment of surgical resectability. If the primary tumor remains unresectable, an orthotopic liver transplantation may be performed.

    Liver transplantation has been a successful therapy for children with unresectable hepatocellular carcinoma; survival is about 60% with most deaths resulting from tumor recurrence.[5,6,7,8]

  • Chemotherapy followed by reassessment of surgical resectability. If the primary tumor remains unresectable, alternative treatment approaches may include the following:
    • Cryosurgery.
    • Intratumoral injection of alcohol.
    • Transarterial chemoembolization.
    • Radiation therapy.

    No specific treatment has proven effective for unresectable hepatocellular carcinoma in the pediatric age group. A prospective study of 41 patients who were to receive preoperative cisplatin/doxorubicin chemotherapy resulted in some degree of decrease in tumor size with a decrease in alpha-fetoprotein (AFP) levels in about 50% of patients. The responders had a superior tumor resectability and survival, although the overall survival (OS) was 28% and only those undergoing complete resection survived.[3] Cryosurgery, intratumoral injection of alcohol, and radiofrequency ablation can successfully treat small (<5 cm) tumors in adults with cirrhotic livers.[4,9,10] Some local approaches such as cryosurgery, radiofrequency ablation, and transarterial chemoembolization that suppress hepatocellular carcinoma tumor progression are used as bridging therapy in adults to delay tumor growth while on a waiting list for cadaveric liver transplant.[11] Transarterial chemoembolization has been used in a few children to successfully shrink tumor size to permit resection.[4,12] (Refer to the PDQ summary on Adult Primary Liver Cancer Treatment for more information.)

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