Interventional Radiology-Guided Procedures in the Treatment of Pediatric Solid Tumors: A Systematic Review and Meta-Analysis

Abstract

Introduction The use of interventional radiology (IR) in the treatment of pediatric solid tumors has markedly increased over the last three decades. However, data on effectiveness of IR-techniques, such as embolization/ablation, are scarce. In this systematic review and meta-analysis, we examined the outcomes of IR-procedures in the treatment of solid tumors in children. Materials and Methods Using a defined search strategy, we searched for studies reporting the use of IR-techniques for pediatric solid tumors from 1980 to 2017. Reports with less than three patients, review, and opinion articles were excluded. The study was conducted under preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We analyzed dichotomous and continuous variables by appropriate statistical methods. Results Of 567 articles screened, 21 papers met the inclusion criteria (12 retrospective, 7 prospective, and 2 randomized-control trials). Many of the analyzed papers described relatively small cohorts of patients. IR-guided procedures were mainly rescue procedures to treat primarily unresectable tumors, local recurrences, or metastases. Inclusion/exclusion criteria and success definition were not specified in most reports. Major side effects were documented in 17/286 (6%) infants, while minor side effects were self-limiting in most patients. Six studies had a comparison between tumor embolization (127 infants) to surgery or chemotherapy without IR-procedures (113 controls). The meta-analysis showed lower mortality (16 vs. 47%) and surgical time for resection (206 vs. 250 m), higher 2-year tumor-free survival (82 vs. 36%), and favorable histology in IR group (p < 0.001 for all). Conclusion IR-guided techniques are promising in the treatment of pediatric solid tumors. Further prospective (randomized) trials are needed to clarify efficacy.

International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines

“…In the last years, ablative therapies have been developing for the treatment of solid tumours in children. The experience is still limited, however, there are some reports on the use of these techniques either for primary pancreatic tumours or liver metastases [ 23 , 24 ].…”

“…Liver metastases may also benefit from a complete surgery at time of the resection of the primary tumour. In most cases, however, surgery is not feasible and other techniques should be considered, such as radiofrequency ablation and chemoembolisation, whose utilisation in children is becoming more and more attractive for various histotypes [ 8 , 34 ].…”

Extra‐appendicular neuroendocrine tumors: A report from the TREP project (2000‐2020)

“…Metastases may also benefit of a complete surgery. In most cases, however, surgery is not feasible and other techniques should be considered, such as radiofrequency ablation and chemoembolization, whose utilization in children is becoming more and more attractive for various histotypes 31,40,41 . OLT has been previously attempted in patients with multifocal metastases limited to the liver 42 .…”

Portal Vein Embolization for Future Liver Remnant Enhancement and Combined Modality Treatment for the Management of Post-hepatic Resection Biliary Fistula in an 18-Month Old Child With Hepatoblastoma

“…This deficiency is mostly due to the absence of tailored materials for children in interventional radiology compounded by the small caliber portal vessels which makes access to these vessels challenging (4). Nonetheless, the use of interventional radiology has markedly increased over the last three decades and have a favorable impact on therapy and outcomes in the treatment of pediatric solid tumors (6).…”