We present our experience in using neoadjuvant regional and systemic
chemotherapy together with surgical resection as a strategy for the treatment of unresectable
hepatoblastoma.
Neoadjuvant chemotherapy was given prior to surgical treatment in six children with unresectable
hepatoblastoma. Furthermore, the
neoadjuvant chemotherapy was intensified according to response to the initial treatment. Surgical resection was performed when the
tumor was judged to be resectable. The
adjuvant chemotherapy was given after delayed primary operation. Five of six children receiving
neoadjuvant chemotherapy responded to the treatment and subsequently received delayed primary operation or living donor
liver transplantation. All five children who had successful surgery have completed treatment and show no evidence of disease to date (27-115 months after surgery). It is concluded that
neoadjuvant chemotherapy given as a combination of regional and systemic
chemotherapy was effective for
tumor reduction in cases with early stage or stage III disease. Also, to increase the cure rate of children with localized disease that was still unresectable after
chemotherapy, living donor
liver transplantation, which offers some advantage in timing of transplant compared with cadaveric
liver transplantation, seems to be a possible procedure.