Pediatric Hepatocellular Carcinoma Follow-up

  • Author: Girindra G Raval, MD; Chief Editor: Max J Coppes, MD, PhD, MBA   more...
 
Updated: Sep 8, 2011
 

Further Inpatient Care

  • Follow-up of patients with hepatocellular carcinomas (HCCs) varies. For the child who requires only surgery, only good postoperative management of the surgical site and assessment of liver function tests may be required. If the α -fetoprotein or B12 binding protein levels are abnormal, these markers of tumor burden, in addition to previously abnormal imaging studies, necessitate close follow-up monitoring. Patients with abnormal scans also require follow-up monitoring, usually at 2-month to 3-month intervals or sooner if clinically indicated.
  • Grade III to grade IV mucositis, grade III to grade IV myelosuppression, febrile neutropenia, anorexia, and cachexia most likely occur in the patient who receives chemotherapy. These problems require hospitalization and management by a team of individuals who are versed in the toxicities of high-dose chemotherapy.
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Prognosis

Survival

The 5-year survival rates for patients undergoing multiagent therapy and surgical resection are as follows:

  • Group I - Approximately 85-90%
  • Group II - 55-60%
  • Groups III and IV - Less than 20%

Surgery is the mainstay of treatment in hepatocellular carcinoma; thus, factors like multifocal tumor, vascular invasion, and presence of metastatic disease, which preclude surgical resection, are important prognostic factors for survival.[1]

Liver transplantation may play a role in the treatment of children with advanced disease; however, survival rates have not exceeded 30% at 2 years follow-up, and distant metastatic disease precludes this therapeutic strategy.

However, one study noted favorable outcomes in children with cirrhosis, hepatocellular carcinoma, and no extrahepatic disease after primary orthotopic liver transplantation. In 8 of 10 patients studied, no tumor recurrence was noted after a median follow up of 4 years.[4]

Another study noted that surgical resection resulted in superior patient survival versus liver transplantation. Of 413 patients studied, 1- and 5-year survival rates were similar in both groups; however, survival rates were significantly improved in resected patients with hepatocellular carcinoma and model end-stage liver disease (MELD) scores of less than 10. Surgical resection should remain the first line of therapy for hepatocellular carcinoma patients who are candidates for resection.[5]

Although chemotherapeutic and radiotherapeutic modalities are associated with numerous toxicities, even a temporary reduction in tumor size can greatly enhance a child's quality of life by alleviating tumor-associated pain and hepatic dysfunction.

Earlier claims for a better outcome of fibrolamellar versus hepatocellular carcinoma have not been substantiated.[1]

Future directions

Identification in a young patient requires a careful evaluation for a preexisting underlying liver disorder. With careful staging and adjuvant therapy, many patients can be treated with intent-to-cure, especially if localized disease is identified in the initial staging workup.

This disease awaits a well-organized clinical trial to best determine which chemotherapeutic agents, duration of therapy, and use of radiation might best benefit affected children. The formation of the Children's Oncology Group within the United States suggests that a clinical trial specifically designed to answer these questions may be forthcoming.

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Contributor Information and Disclosures
Author

Girindra G Raval, MD  Staff Physician, Department of Internal Medicine, University of Arkansas School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Paulette Mehta, MD, MPH  Professor of Hematology/Oncology, Department of Internal Medicine, Co-Director of Fellowship Program, Medical Director of Hematology/Oncology at CAVHS, University Arkansas for Medical Sciences and Central Arkansas Veterans Hospital System

Paulette Mehta, MD, MPH is a member of the following medical societies: American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, and American Society of Hematology

Disclosure: Nothing to disclose.

Specialty Editor Board

Stephan A Grupp, MD, PhD  Director, Stem Cell Biology Program, Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia; Associate Professor of Pediatrics, University of Pennsylvania School of Medicine

Stephan A Grupp, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Hematology, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Steven K Bergstrom, MD  Department of Pediatrics, Division of Hematology-Oncology, Kaiser Permanente Medical Center of Oakland

Steven K Bergstrom, MD is a member of the following medical societies: Alpha Omega Alpha, American Society of Clinical Oncology, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and International Society for Experimental Hematology

Disclosure: Nothing to disclose.

Helen SL Chan, MBBS, FRCP(C), FAAP  Senior Scientist, Research Institute; Professor, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada

Helen SL Chan, MBBS, FRCP(C), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Max J Coppes, MD, PhD, MBA  Senior Vice President, Center for Cancer and Blood Disorders, Children's National Medical Center; Professor of Medicine, Oncology, and Pediatrics, Georgetown University School of Medicine; Clinical Professor of Pediatrics, George Washington University School of Medicine and Health Sciences

Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American Association for Cancer Research, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Stuart Winter, MD, to the development and writing of this article.

References

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