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Pediatr Radiol. 2018 Apr;48(4):555-564. doi: 10.1007/s00247-018-4068-1. Epub 2018 Jan 23.

Role of interventional radiology in managing pediatric liver tumors : Part 1: Endovascular interventions.

Author information

1
Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Road Room 1862, Stanford, CA, 94305-5913, USA. mlungren@stanford.edu.
2
Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
3
Department of Radiology, Great Ormond Street Hospital, London, UK.
4
Department of Radiology, Division of Interventional Radiology, Seattle Children's Hospital, Seattle, WA, USA.
5
Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, Atlanta, GA, USA.
6
Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.
7
Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Road Room 1862, Stanford, CA, 94305-5913, USA.
8
Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA.
9
Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Abstract

Primary liver malignancies are rare in children. Hepatoblastoma and hepatocellular carcinoma (HCC) together represent the overwhelming majority of cases. Overall survival of hepatoblastoma approaches 80% with multimodal treatment approaches that include chemotherapy, surgery and transplantation. However, there remains a subset of children with hepatoblastoma in whom resection or transplantation is not possible. The 5-year survival for children diagnosed with HCC is less than 30% and remains a significant therapeutic challenge. The poor outcomes for children with primary liver tumors motivate investigation of new therapeutic alternatives. Interventional oncology offers a broad scope of percutaneous and transcatheter endovascular cancer therapies that might provide clinical benefits. Minimally invasive approaches are distinct from medical, surgical and radiation oncologic treatments, and in adults these approaches have been established as the fourth pillar of cancer care. Transarterial chemoembolization is a minimally invasive locoregional treatment option performed by interventional radiologists with level-I evidence as standard of care in adults with advanced liver malignancy; transarterial chemoembolization in adults has served to prolong disease-free progression, downstage and bridge patients for surgical and transplant interventions, and improve overall survival. However, while several groups have reported that transarterial chemoembolization is feasible in children, the published experience is limited primarily to small retrospective case series. The lack of prospective trial evidence has in part limited the utilization of transarterial chemoembolization in the pediatric patient population. The purpose of this article is to provide an overview of the role of interventional radiology in the diagnosis and endovascular management of hepatic malignancies in children.

KEYWORDS:

Children; Hepatoblastoma; Hepatocellular carcinoma; Interventional radiology; Transarterial chemoembolization

PMID:
29362840
DOI:
10.1007/s00247-018-4068-1
[Indexed for MEDLINE]

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