Preliminary experience with arterial chemoembolization for hepatoblastoma and hepatocellular carcinoma in children.

The objective of this work was to test feasibility and efficacy of hepatic artery chemoembolization (HACE) in unresectable malignant liver tumors. Five patients aged from 1-12 years were treated in the Medical University of Gdansk from 1999 to 2002. All had locally advanced tumors, which did not respond to systemic chemotherapy: four, hepatoblastoma (HB) and one, hepatocellular carcinoma (HCC). Arteriography was performed and chemoembolization suspension (cisplatin + doxorubicin + mitomycin mixed with lipiodol) was injected, followed by gelatin foam particles. The procedure was performed one to three times in each patient. In four patients (three, HB, one, fibrolamellar HCC), tumor response was observed, with decrease in the diameter of the mass of 25-33% and fall in the AFP level of 83-99%. One child with HB was non-evaluable due to early death caused by systemic myelotoxicity. Two patients (2 HB) underwent macroscopically complete tumor resection, 1 is alive and well, and 1 died at the end of surgery for an unknown reason (possibly related to cardiotoxicity of earlier systemic chemotherapy). One HB patient was successfully transplanted after two HACE courses. The only HCC patient died because of pulmonary oil embolism immediately after the third HACE course. HACE can lead to tumor regression in most cases and may be considered an alternative for patients with unresectable liver tumors who do not respond to primary systemic chemotherapy and are not candidates for liver transplantation for various reasons.

Pulmonary embolism: a fatal complication of arterial chemoembolization for advanced hepatocellular carcinoma.

The case of a child with advanced hepatocellular carcinoma that did not respond to systemic chemotherapy is presented. Three courses of chemoembolization (hepatic arterial chemoembolization) were given, with partial tumor response. The hepatic artery was cannulated via the femoral artery using the Seldinger technique. Arteriography was performed, and chemoembolization suspension (cisplatin + doxorubicin + mitomycin mixed with Lipiodol) was injected. After the third hepatic arterial chemoembolization, the patient developed fatal pulmonary oil embolism. Hepatic arterial chemoembolization seems to be a useful method for treatment of high-risk hepatocellular carcinoma cases, which can induce responses, even in metastatic patients refractory to standard systemic chemotherapy. However, it may result in pulmonary embolism, which is a potentially fatal complication. In children, Lipiodol should be used as an embolizing material and cytostatic carrier with extreme care. Consideration should be given to replacing it with other materials, including albumin or collagen.

[Malignant pelvic neoplasms in children treated in two Polish oncology centres]. / Nowotwory zlosliwe miednicy mniejszej u dzieci w materiale dwóch osrodków onkologicznych w Polsce.

BACKGROUND: Extensive diagnostic and therapeutic dilemmas appear in children With primary malignant neoplasms located in the minor pelvis. THE AIM OF THE STUDY: To evaluate the clinical symptoms, disease course and the results of treatment in patients with malignant pelvic neoplasms. MATERIAL AND METHODS: The study included 31 children (13 boys and 18 girls; aged 2 months to 16 years; mean age -- 8 years) treated in the Departments of Paediatric Oncology and Haematology in Gdansk and Lublin during the period of 1992-2003. The group comprised 17 patients with soft tissue sarcomas (MTM) (55%), 12 with germinal tumours (TGM) (39%) and tow. with neuroblastoma (NBL) (6%). The great majority of children (90%) presented with highly advanced disease (stages III + IV -- in 28 out of 31 patients). RESULTS: with data analysis we were able to distinguish two categories of patients with different prognosis: with MTM and TGM. Most of he MTM tumours (11/17 - 65%) were localized in the urinary tract, the remaining six developed within pelvic muscles. Ten out of twelve TGM tumours (83%) were located in the ovaries. Radical tumour resection, especially primary resection, was shown to play the key role in both groups. Among TGM patients it was performed in 75% while in MTM patients -- in only 12%. All of these patients entered clinical remission and remain disease free. After adjuvant chemo- and/or radiotherapy secondary tumour resection was done in 17% of TGM and 41% of MTM patients. CONCLUSION: in patients, who were not able to undergo radical tumour resection (mainly MTM patients), the disease progressed and led to death.

[Stage IV Wilms' tumour -- analysis of treatment results, according to the SIOP 93-01 protocol, at the Medical University of Gdansk]. / Guz Wilmsa w IV stadium -- analiza wyników leczenia wedlug protokolu SIOP 93-01 w osrodku gdanskim.

THE AIM OF THE STUDY: To evaluate the results of treatment in patients with Wilm's' tumor in stage IV at the Gdansk Medical University Centre. MATERIAL AND METHODS: Between 1993 and 2002, 44 children with nephroblastoma were treated according to SI0P 93-01 protocol, in the Department of Paediatrics, Haematology, Oncology and Endocrinology of the Medical University of Gdansk. Stage IV tumour was confirmed in 6 children: 3 boys and 3 girls. Metastases into the lungs were identified in 4 patients, into the lungs and liver in l child and into the right atrium wall in l child. RESULTS: After preoperative chemotherapy complete regression of metastases was obtained in 3 patients. Partial regression was obtained in 2 patients. In l patient there was no effect of preoperative treatment. In all patients nephroblastoma of intermediate histological risk was diagnosed. Among the 6 analysed patients with stage IV of the disease, 5 children are alive. Time of observation is from 42 to 102 months. 1 child died from treatment complications: necrotising enteritis.

[Wilms' tumour of unfavorable histology--results of treatment with the SIOP 93-01 protocol at the Gdansk centre. Preliminary report]. / Guz Wilmsa o budowie histologicznej niekorzystnej -- analiza wyników leczenia wedlug protokolu SIOP 93-01 w osrodku gdanskim. Doniesienie wstepne.

BACKGROUND: Wilms' tumour is the most common primary renal tumour of childhood. The aim or the study was to evaluate the results of treatment in patients with unfavourable histology Wilms' tumour. MATERIAL AND METHODS: 44 children were treated for nephroblastoma (Wilms' tumour) according to the SIOP 93-01 protocol in the Department of Paediatrics. Haematology. Oncology and Endocrinology, Medical University of Gdansk, between 1993 and 2002. Eleven children were classified as having tumours with high-grade malignancy. Among these 2 cases of nephroblastoma with diffuse anaplasia, 6 with sarcomatous stroma and 2 cases with clear cell sarcoma of the kidney were diagnosed. In one patient file tumour structure was undefined due to complete necrosis of the tumour tissue. The staging stratification was as follows: stage I-l, II N (-)-l, II N (+) -3, III- 6, including a neoplasmic occluding thrombus in the inferior vena cava, IV - 0, V-0. All children were treated according to the SIOP 93-01 protocol. RESULTS: complete remission was achieved in 9 patients. Two children died. Fatal outcome was attributed in one case to cancer progression (primary resistance to chemotherapy after 14 months of treatment) and in the other, to the treatment complications (fungal sepsis after undergoing the third course of chemotherapy Carbo+ VP-16). In the analysed group there were no patients with stage IV disease, no relapses were observed. CONCLUSIONS: our observations support the opinion, that high-grade malignancy histology is the basic unfavourable prognostic factor in nephroblastoma.