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Role of interventional radiology in managing pediatric liver tumors

Part 1: Endovascular interventions

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Abstract

Primary liver malignancies are rare in children. Hepatoblastoma and hepatocellular carcinoma (HCC) together represent the overwhelming majority of cases. Overall survival of hepatoblastoma approaches 80% with multimodal treatment approaches that include chemotherapy, surgery and transplantation. However, there remains a subset of children with hepatoblastoma in whom resection or transplantation is not possible. The 5-year survival for children diagnosed with HCC is less than 30% and remains a significant therapeutic challenge. The poor outcomes for children with primary liver tumors motivate investigation of new therapeutic alternatives. Interventional oncology offers a broad scope of percutaneous and transcatheter endovascular cancer therapies that might provide clinical benefits. Minimally invasive approaches are distinct from medical, surgical and radiation oncologic treatments, and in adults these approaches have been established as the fourth pillar of cancer care. Transarterial chemoembolization is a minimally invasive locoregional treatment option performed by interventional radiologists with level-I evidence as standard of care in adults with advanced liver malignancy; transarterial chemoembolization in adults has served to prolong disease-free progression, downstage and bridge patients for surgical and transplant interventions, and improve overall survival. However, while several groups have reported that transarterial chemoembolization is feasible in children, the published experience is limited primarily to small retrospective case series. The lack of prospective trial evidence has in part limited the utilization of transarterial chemoembolization in the pediatric patient population. The purpose of this article is to provide an overview of the role of interventional radiology in the diagnosis and endovascular management of hepatic malignancies in children.

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Authors and Affiliations

  1. Department of Radiology, Lucile Packard Children’s Hospital, Stanford University School of Medicine, 725 Welch Road Room 1862, Stanford, CA, 94305-5913, USA

    Matthew P. Lungren & Avnesh Thakor

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

    Alexander J. Towbin

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

    Derek J. Roebuck

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

    Eric J. Monroe

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

    Anne E. Gill & C. Matthew Hawkins

  6. Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children’s Healthcare of Atlanta at Egleston, Atlanta, GA, USA

    Anne E. Gill & C. Matthew Hawkins

  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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  1. Matthew P. Lungren
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Lungren, M.P., Towbin, A.J., Roebuck, D.J. et al. Role of interventional radiology in managing pediatric liver tumors. Pediatr Radiol 48, 555–564 (2018). https://doi.org/10.1007/s00247-018-4068-1

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