Treating Pediatric Hepatocellular Carcinoma with Transcatheter Arterial Chemoembolization

Purpose: Hepatocellular carcinoma (HCC) is the most deadly primary hepatic cancer in the pediatric population. Although interventional radiology is not a mainstay of treatment currently, it has been seen to be a viable option to prolong survival and as a bridge to transplantation. This is a review of the literature and presentation of a case of a 15-year-old girl in whom 6 rounds of transcatheter arterial chemoembolization (TACE) over the span of 9 months was able to prolong survival.

Materials and Methods: A complete literature investigation in PubMed and Google Scholar search engines using the keywords of “pediatric HCC treatment,” “children TACE,” “pediatric TACE,” and “pediatric interventional radiology HCC” was performed. Our institution’s electronic medical records were accessed to obtain relevant clinical and treatment information. Images were obtained from preprocedural and follow-up cross-sectional and arteriogram imaging.

Results: TACE is reserved for cases of unresectable HCC. The majority of studies in the literature in regard to TACE in HCC patients have a median age between 60 and 70 years. We found 18 reported pediatric cases of HCC treated with TACE, ranging from 1.4 to 17 years of age. Our patient was a 15-year-old female patient with a nonmetastatic fibrolamellar subtype of HCC. Her liver was enlarged to 28 cm in craniocaudal dimension because of the extensive initial tumor burden, which occupied nearly all of the segments of the liver. The patient was not a candidate for tumor resection and received systemic chemotherapy with cisplatin and doxorubicin before undergoing TACE. Our patient underwent a total of six TACE procedures with an average of 21.3 mg of doxorubicin via 0.4 to 1 vial(s) of 100- to 300-μm drug-eluting microspheress over the span of 9 months. Tumor response was visualized on follow-up cross-sectional imaging, which depicted a drastic decrease in the size of tumor burden and evidence of necrosis.

Conclusions: There exists sparse data on the use of TACE in the setting of pediatric HCC. This uncommonly used procedure has resulted in successful outcomes of prolonged survival and bridge to transplant as presented by our case. Several cases in the literature have similar responses and favorable outcomes. This knowledge is valuable to interventional radiologists because they can combat this disease in this patient population.