TACE May Help to Bridge Pediatric HCC Patients to Transplantation
Transarterial chemoembolization (TACE) seems to be a safe and effective treatment option to manage hepatic tumor burden and for downstaging and bridging to liver transplantation in children with unresectable hepatocellular carcinoma (HCC).
Children with HCC who are not resectable and cannot undergo transplant have low rates of long-term survival. These children are often given systemic chemotherapy in the hope of bridging to resection or transplantation, but chemotherapy is not able to reliably reach these goals and is accompanied by risks of toxicity. TACE may offer an alternative or adjunctive option for treating locally advanced TACE, but research is scarce on its effectiveness in children, though it is known to be an effective treatment for adults with HCC.
To gain more information on the safety and efficacy of TACE in children, researchers conducted a retrospective analysis of data from 8 patients who underwent TACE for unresectable HCC. The patients were aged 4 to 17 years and had a mean age of 12.5 years.
Patients’ response to TACE was assessed based on change in AFP, RECIST and tumor volume, PRETEXT, and transplantation eligibility by UCSF and Milan criteria. After the procedure, patients were followed for a mean of 8.2 years, and the researchers found that percent change in AFP ranged from a decrease of 100% to an increase of 89.3%, with a mean change of −49.6%.
Of the 8 patients in the study, 6 underwent orthotopic liver transplantation with mean first TACE-to-transplant interval of 141 days. Five patients survived to the end of the follow-up period after the transplantation, but one died of recurrent disease. Two patients died of progressive disease and did not undergo resection or transplantation.
The researchers recommended a larger trial of TACE in pediatric patients based on their encouraging initial results. “In conclusion, TACE for children with unresectable HCC can be
a safe and effective method for managing hepatic tumor burden, particularly as a bridging or downstaging strategy to liver transplantation. Despite differences in underlying risk factors, liver function, and tumor biology, HCC in children may be amenable to the same treatment approaches that are currently used in adult patients,” the authors wrote.
Weiss KE, Sze DY, Rangasawami, et al. Transarterial chemoembolization in children to treat
unresectable hepatocellular carcinoma. Pediatric Transplantation. 26 Feb 2018. Online ahead of print. DOI: 10.1111/petr.13187