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

Recurrent Hepatoblastoma

The prognosis for a patient with recurrent or progressive hepatoblastoma depends on many factors, including the site of recurrence, prior treatment, and individual patient considerations. For example, in patients with stage I hepatoblastoma at initial diagnosis, aggressive surgical treatment of isolated pulmonary metastases that develop in the course of the disease may make extended disease-free survival possible.[1,2] Analysis of survival after recurrence demonstrated that some patients treated with cisplatin/vincristine/fluorouracil could be salvaged with doxorubicin-containing regimens, but patients treated with doxorubicin/cisplatin could not be salvaged with vincristine/fluorouracil.[3] Addition of doxorubicin to vincristine/fluorouracil/cisplatin is under clinical evaluation in the Children's Oncology Group (COG) study COG-AHEP0731. Combined vincristine/irinotecan has been used with some success.[4][Level of evidence: 3iiiA] If possible, isolated metastases should be resected completely in patients whose primary tumor is controlled.[5] Liver transplant should be considered for patients with isolated recurrence in the liver.[6,7,8] Treatment in a clinical trial should be considered if all of the recurrent disease cannot be surgically removed. Phase I and phase II clinical trials may be appropriate and should be considered.

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Recurrent Hepatocellular Carcinoma

The prognosis for a patient with recurrent or progressive hepatocellular carcinoma is poor.[9] Chemoembolization or liver transplant should be considered for those with isolated recurrence in the liver.[6,7,8] Phase I and phase II clinical trials may be appropriate and should be considered. (Refer to the PDQ summary on Adult Primary Liver Cancer Treatment for more information.)

Sorafenib has resulted in improved progression-free survival in adults with advanced hepatocellular carcinoma. For adult patients who received sorafenib, the median survival and time to radiologic progression were about 3 months longer than those who received a placebo.[10] A phase I trial has been completed in children, and a single-agent, phase II COG trial is underway. Limited data from a European pilot study suggest that sorafenib may have been beneficial to 12 newly diagnosed patients with advanced hepatocellular carcinoma when given in combination with standard chemotherapy with cisplatin and doxorubicin.[11]

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