Clinical

Hepatic metastasectomy feasible for some children with solid tumors

Last Updated: 2007-06-13 15:46:26 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Liver resection for metastases is safe and beneficial for selected children with solid tumors, according to a report in the May 15th issue of Cancer.

"Physicians should realize that this is feasible, safe, and may prolong survival in selected cases," Dr. Michael P. La Quaglia from Memorial Sloan-Kettering Cancer Center, New York told Reuters Health.

Dr. La Quaglia and colleagues describe outcomes of 15 children who underwent resection of hepatic metastases from primary tumors that included 7 neuroblastomas, 3 Wilms tumors, 2 osteogenic sarcomas, 2 desmoplastic small round cell tumors, and 1 malignant epithelial neoplasm of the stomach.

There were no deaths intraoperatively or postoperatively, the results indicate. Two children experienced postoperative complications -- one wound infection and one bile collection.

None of the children experienced hepatic insufficiency postoperatively, the researchers note, and all patients were fully ambulatory and taking a normal diet at the time of discharge.

Median survival was 9 months overall, the report indicates, and three patients remain alive after hepatic metastasectomy, one with no evidence of disease 9.5 years later. Four patients experienced hepatic recurrence.

"The decision to perform localized resection of liver metastases still remains a highly selective one," the investigators conclude. "Prerequisites for hepatic metastasectomy include the control of the primary site, no evidence of extrahepatic disease, adequate hepatic reserve for resection, and a clear understanding of tumor biology."

"The procedure should be done only after careful evaluation of disease extent as well as the status of the patient," Dr. La Quaglia said. "This therapy should be done as part of a multidisciplinary treatment approach."

Dr. La Quaglia outlined plans for studying other approaches to hepatic metastases in children: "We are initiating a program of hepatic arterial infusion like that that used for colon cancer. We will try to use tumor-specific agents, including monoclonals, in the future."

Cancer 2007;109:2089-2092.