164                                                                                                                                            Hepatoblastoma

 

29.                Hepatoblastoma

29.1        General considerations

Hepatoblastoma typically is a tumor of very young children. Complete resection offers a chance of cure, but the relapse rate after surgery alone was high and more than half of all patients presents with unresectable primary tumors or distant metastases at diagnosis. Bacause hepatoblastoma turned out to be a chemosensitive tumor, some study groups recommend starting treatment with preoperative chemotherapy, while others start with surgery followed by adjuvant chemotherapy.

 

Literature: for review

            HERZOG et al, Oncologist 5 (2000): 445 – 453

            PERILONGO and SHAFFORD, Eur. J. Cancer 35 (1999): 953 – 958

            RANEY, J. Pediatr. Hematol. Oncol. 19 (1997): 418 – 422

            REYNOLDS, Semin. Pediatr. Surg. 10 (2001): 140 – 145

 

29.2     PLADO (SIOPEL – 1)     

Cisplatin                               80 mg/m2                 i.v. (cont inf)                     d 1

Doxorubicin                          30 mg/m2                i.v. (cont inf)                     d 2+3

       To be repeated every 3 weeks (4-6 courses followed by an attempt of resection)

           

            Literature:

                        PRITCHARD et al, J. Clin. Oncol. 18 (2000): 3819 – 3828

 

29.3             Cisplatin + 5 –fluorouracil + vincristine (Intergroup Hepatoma study)

Cisplatin                                 90 mg/m2 *              i.v. (6 h inf)                    d 1 or

                                                3 mg/kg **              i.v. (6 h inf)                    d 1

Vincristine                              1.5 mg/m2                i.v. (bolus)                     d 2

5-Fluorouracil                         600 mg/m2               i.v. (bolus)                     d 2

To be repeated every 3 weeks at the earliest (4 cycles. Stage I or II patients who had no evidence of disease at that time were not treated further and entered to follow up. All others who did not have progressive disease were eligible to surgery followed by 2-4 additional cycles based on the completeness of surgery. Patients who received 8 cycles of chemotherapy were eligible for postinduction surgery II, if  deemed feasible).

*       ≥ 1 year of age

            **     < 1 year of age

 

Literature:

            ORTEGA et al, J. Clin. Oncol. 18 (2000): 2665-2675

 

29.4             IPA / PA-CI (GPOH HB89)

IPA

Ifosfamide                          500 mg/m2                   i.v. (bolus)                           d 1 and

                                           3000 mg/m2            i.v. (cont inf)                       d 1 – 3

                                                                          with mesna uroprotection

Cisplatin                             20 mg/m2                i.v.                                       d 4 – 8

Doxorubicin                       60 mg/m2               i.v. (cont inf)                       d 9 + 10

To be repeated every 3 weeks for 2 courses, then re-evaluation for resectability.

 

 Hepatoblastoma                                                                                                                                          165

 

If resection was still not possible, two more coursed of chemotherapy:

 

PA-CI

Cisplatin                          90 mg/m2                   i.v. (4 h inf)                          d 1

Doxorubicin                     80 mg/m2                  i.v. (cont inf)                        d 2-5

 

Literature:

            Von SCHWEINITZ et al, Eur. J. Cancer 33 (1997) : 1243-1249