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Role of interventional radiology in managing pediatric liver tumors

Part 2: percutaneous interventions

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Abstract

Hepatoblastoma and hepatocellular carcinoma (HCC) are the most common pediatric liver malignancies, with hepatoblastoma occurring more commonly in younger children and HCC occurring more commonly in older children and adolescents. Although surgical resection (including transplant when necessary) and systemic chemotherapy have improved overall survival rate for hepatoblastoma to approximately 80% from 30%, a number of children with this tumor type are not eligible for operative treatment. In contradistinction, pediatric HCC continues to carry a dismal prognosis with an overall 5-year survival rate of 30%. The Paediatric Hepatic International Tumour Trial (PHITT) is an international trial aimed at evaluating both existing and emerging oncologic therapies for primary pediatric liver tumors. Interventional radiology offers a number of minimally invasive procedures that aid in diagnosis and therapy of pediatric liver tumors. For diagnosis, the PHITT biopsy guidelines emphasize and recommend percutaneous image-guided tumor biopsy. Additionally, both percutaneous and endovascular procedures provide therapeutic alternatives that have been, to this point, only minimally utilized in the pediatric population. Specifically, percutaneous ablation offers a number of cytotoxic technologies that can potentially eradicate disease or downstage children with unresectable disease. Percutaneous portal vein embolization is an additional minimally invasive procedure that might be useful to induce remnant liver hypertrophy prior to extended liver resection in the setting of a primary liver tumor. PHITT offers an opportunity to collect data from children treated with these emerging therapeutic options across the world. The purpose of this manuscript is to describe the potential role of minimally invasive percutaneous transhepatic procedures, as well as review the existing data largely stemming from the adult HCC experience.

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, Atlanta, GA, USA

    C. Matthew Hawkins & Anne E. Gill

  2. Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children’s Healthcare of Atlanta at Egleston, 1364 Clifton Road NE, Suite D112, Atlanta, GA, 30322, USA

    C. Matthew Hawkins & Anne E. Gill

  3. Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Alexander J. Towbin

  4. Department of Radiology, Great Ormond Street Hospital, London, UK

    Derek J. Roebuck

  5. Department of Radiology, Division of Interventional Radiology, Seattle Children’s Hospital, Seattle, WA, USA

    Eric J. Monroe

  6. Department of Radiology, Lucille Packard Children’s Hospital, Stanford University, Stanford, CA, USA

    Avnesh S. Thakor & Matthew P. Lungren

  7. Department of Radiology, Phoenix Children’s Hospital, Phoenix, AZ, USA

    Richard B. Towbin

  8. Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Anne Marie Cahill

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Matthew Hawkins, C., Towbin, A.J., Roebuck, D.J. et al. Role of interventional radiology in managing pediatric liver tumors. Pediatr Radiol 48, 565–580 (2018). https://doi.org/10.1007/s00247-018-4072-5

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