Health Status in Long-Term Survivors of Hepatoblastoma

Abstract

The aim of this study was to evaluate the health status of children cured from hepatoblastoma. Forty-five patients with hepatoblastoma treated between 1996–2014 were assessed. The recorded data included sex, age at diagnosis, disease stage, treatment methods, time since diagnosis, and the evaluation of health status domains which included performance status, growth development, hearing, cardiovascular, skeletal, gastrointestinal, genitourinary, neurological, and hematological function. There were 30 boys and 15 girls. The age at diagnosis ranged from one month to 14 years (median one year). At the time of the health status evaluation, the youngest patient was 5.5 years old and the oldest was 21 years of age (median—10 years). All patients were treated according to the Childhood Liver Tumors Strategy Group—SIOPEL recommendations, though they were not active participants of the studies. The median cumulative dose of cisplatin was 520 mg/m2 and 360 mg/m2 for doxorubicin. Thirty-six patients underwent partial hepatectomy, and nine total hepatectomy and liver transplantation. At a median of nine years from diagnosis, 68% of hepatoblastoma survivors had experienced at least one chronic health condition of any grade. The most frequent late complication was ototoxicity (28.8%), and the most serious were second malignancies (6.6%) and cardiomyopathy (4.4%). Conclusion: Survivors of hepatoblastoma are at risk for long-term complications. They require long-term monitoring for late effects.

Predictors of survival following liver transplantation for pediatric hepatoblastoma and hepatocellular carcinoma: Experience from the Society of Pediatric Liver Transplantation (SPLIT)

“…The combination of nephrotoxic chemotherapy and posttransplant medications (namely calcineurin inhibitors) likely contribute to increased renal injury, suggesting a role for closer monitoring of renal function in HB transplants and consideration of renal‐protective immunosuppression regimens, including mTOR inhibitors. The sustained impact on renal function in HB transplants is not well‐understood and requires further attention in considering long‐term health 25 …”

“…The sustained impact on renal function in HB transplants is not wellunderstood and requires further attention in considering longterm health. 25 The lack of centralized pathology review in this study limits our ability to draw definitive conclusions regarding the effect of HB histologic subtypes on outcomes following LT. As previously described, pure fetal histology with low mitoses was associated with excellent survival. 11,26,27 The poorer EFS for epithelial tumors compared to mixed epithelial/mesenchymal tumors has not been These limitations must be considered when interpreting survival outcomes.…”

Vincristine/irinotecan/temsirolimus upfront window treatment of high‐risk hepatoblastoma: A report from the Children's Oncology Group AHEP0731 Study Committee

“…The mainstay of most chemotherapy regimens has been cisplatin and doxorubicin, which are dose-limited due to renal, auditory, and cardiac toxicities. [9][10][11][12][13] Other agents such as carboplatin, ifosfamide, and etoposide have also been used in various combinations with minimal improvement in EFS. 4,14 Because of the rarity of HB, traditional phase I and phase II clinical trial mechanisms have generally been unsuccessful in identifying novel effective agents.…”

“…Chemotherapy is an essential part of treatment for this high‐risk patient group. The mainstay of most chemotherapy regimens has been cisplatin and doxorubicin, which are dose‐limited due to renal, auditory, and cardiac toxicities 9–13 . Other agents such as carboplatin, ifosfamide, and etoposide have also been used in various combinations with minimal improvement in EFS 4,14 .…”

Second Malignant Neoplasms Following Treatment for Hepatoblastoma: An International Report and Review of the Literature

“…11 In a study from Poland of 45 patients with HB identified at the authors' institution, a SMN rate of 6.6% was reported. 12 In another Japanese study of 361 patients with HB treated on the Japanese Study Group for Paediatric Liver Tumours-2 trial protocol, the authors found an increased risk of SMNs with a higher pirarubicin dose and a lower age at diagnosis. 13 Chemotherapeutic agents used in HB treatment are known to be associated with an increased risk of the development of SMNs.…”