Effectiveness of Preoperative Transcatheter Arterial Chemoembolization in Hepatoblastoma

Purpose : To evaluate the effectiveness of transcatheter arterial chemoembolization(TACE) as a preoperative treatment for initially unresectable hepatoblastomas. Methods : From January 1995 to July 1999, we identified two boys and three girls(age range : 527 months; mean age : 12 months) with pathologically-confirmed hepatoblastoma. To assess response to treatment, we utilized an identical TACE procedure for all the patients. A second TACE procedure was performed 3 weeks after the first TACE procedure and patients underwent tumor resection approximately 1 month following the second TACE procedure. The therapeutic responses to TACE were assessed by measuring of tumor size, shape, observation of tumor properties using abdominal computed tomography(CT), gross and microscopic pathologic findings, levels of alphafeto protein(AFP) and clinical adverse events to TACE. Results : In these patients, hepatoblastomas showed marked reductions in tumor size. Massive tumor necrosis and homogeneous distribution of lipiodol created a clear margin bordered by surrounding normal liver tissue. At initial diagnosis, the mean AFP level=867.4ng/mL, 47.4ng/mL after second TACE, and 8.6ng/mL at 6 months after surgical resection. Transient fever was observed following TACE and elevations of levels of AST and ALT were observed but these normalized 2 weeks following TACE. No major complications were associated with TACE. Conclusion : We suggest that preoperative TACE is an effective, safe, and useful method for patients with initially unresectable hepatoblastoma. (J Korean Pediatr Soc 2000;43:1098-1105)