| Background:Hepatoblastoma (HB) accounted for about 1% of children's cancer incidence. Also is the most common childhood malignant liver solid tumor, takes up about 50% to 60% in children primary liver cancer and 25% to 45% in all liver tumor lesions. As this disease is highly malignant, has short course and low rate of tumor resection, meanwhile, the prognosis is poor, so HB is still one of the intractable diseases of children's cancer till today.In the treatment, complete tumor resection is considered as the most important way to cure this disease, and the resection rate would affect the prognosis directly. But almost 50% of children with HB couldn't have complete surgical sections once because the tumors are too big and infiltrate extensively , in addition, about 20% have distant metastasis. After 1980s, there are some new chemotherapy drugs and the chemotherapy had been improved constantly. Especially when the platinum-based chemotherapy was applied to the treatments, the prognosis of HB was improved a lot, the 5-year survival rate reached 75% or even higher. At present, the treatment of HB in our country is similar to the treatments in American Children Cancer Research Group CCG and POG. The recommended program is to take surgical resection if the tumor could be resected completely once, combined with chemotherapy after surgery. If the tumor couldn't be resected completely once, take a biopsy to clear the diagnosis at first, then give preoperative chemotherapy, take delayed operation, and use chemotherapy after operation, it improves the efficacy to some degree. However, systemic chemotherapy affects through peripheral veins, many of the anti-cancer drugs have already combined with plasma proteins because they have to take a long way to reach the liver, and it would decrease the efficacy significantly and cause severe systemic toxicity, or even cause death to some patients. In the last decade, as the medical intervention was used widely in clinical medicine, some scholars chose to use transcatheter arterial chemoembolization (TACE) first, then take surgical resection in HB which can not be resected complely once, and got good results. So TACE has become an important preoperative chemotherapy for nresectable HB.Objective:1. To explore relevance between alpha fetal protein(AFP)lever and tumor staging,histopathologic types, tumor volume of HB children.2. To explore if TACE could be used as a preoperative treatment in unresectable huge HB to bring chances for surgical resection by lower the HB children's AFP level and reduce the tumor volume, and verify the clinical possibilities and efficacy of TACE as a treatment for HB.3. To explore if TACE could improve HB children ' s nutrition condition by heighten the haemoglobin and albumin, increase their tolerance of surgery and improve the prognosis.4. To research the toxicity and safety of TACE as a treatment for HB.Methods:1. Collected the informations of 25 cases that was accepted as HB children without treatments during March 2007 to March 2011 in Guangzhou Women and Children ' s Hospital, one of them abandoned treatment because of portal vein tumor, was not included in this research. In those 24 cases, 14 males, 10 females, the ratio was 1.4: 1. The Age was from 26 days to 3 years and 5 months old, average age, 14 months old. They were diagnosed as HB according to the clinical symptoms, Ultrasound results, CT scan, AFP values and liver tumor biopsy. 13 of them belongs to fetal type, 7 of them belongs to embryonal type and the rest, anaplastic type. Preoperative checks showed that the heart, liver, lung, kidney function and coagulation of all of them were normal.2. In this research, 3 cases were in stageⅡA , 11 cases were in stageⅡB, 5 cases were in stageⅢA , 5 cases were in stageⅢB , according to the CCSG staging.3. All those 24 patients accepted TACE because the tumors were too big to be resected by surgical operations once. All patients were adopt the Seldinger's technique to puncture femoral and intubate to find the blood vessel of tumor by digital subtraction angiography (DSA)examination. Superselective intubate and chemoembolized the blood vessel of tumor by applying the admixture of pirarubicin hydrochloride (THP),cisplatin (CDDP) and iodinate oil. Finally, the blood vessel of tumor was embolized by polyvinyl alcohol (PVA)。The tumor volume and AFP level on CT images in 4-6 weeks after taking TACE would be considered as the indicators to evaluate the effect, to compare the relevance of AFP, tumor level, hemoglobin, cardiac toxicity, liver and kidney functions with TACE.4. All the data in our study were analyzed by Software SPSS 13.0. P<0.05 was considered as statistically significant, P<0.01 was considered as statistically significant apparently.Results:1. This study showed that there is no difference between the HB staging (Ⅱstage andⅢstage) and the AFP level (119921.9±175320.39 vs155537.9±185475.27, t=-0.474, P=0.641). The comparison of the difference between 3 pathological types and the AFP levels didn't show statistical significance (Z=0.100, P =0.951). Besides, tumor volume is not associated with the AFP level (r=0.33, P =0.115).2. Through using the Nonparametric tests respectively about the AFP values of the times that before taking TACE, after the first time to take TACE and after the last time to take TACE. We found out that all the group data were statistically significant(Z=-4.286, P<0.001; Z=-4.107,P<0.001; Z=-4.143, P<0.001). The result of the repeated variance analysis (F=4.344, P =0.016) meant that the time effect had statistical significance.3. Through using the paired t tests respectively about the tumor volume values of the time that before taking TACE, after the first time to take TACE and after the last time to take TACE. We found out that all the group data were statistically significant (t=6.315, P<0.01; t=7.570, P <0.01; t=6.972, P <0.01). The result of the repeated variance analysis (F=29.996, P <0.001) meant that the time effect had statistical significance.4. The hemoglobin and albumin values of HB children after taking TACE is apparently higher than without TACE (114.54±12.77vs90.33±8.31, t=-8.149, P <0.01; 44.08±3.64vs35.21±2.94, t=-11.0, P<0.01).5. The creatine kinase values of HB children before and after taking TACE are similar(116.70±31.57vs120.39±26.08, t=-0.733, P=0.472); The creatinine values of HB children before and after taking TACE are also similar (22.71±5.03vs21.75±4.42, t=0.398, P=0.694); The alanine amino transferase (ALT) lever showed difference (26.33±17.24vs33.04±13.71, t=-2.332, P=0.029), as the ALT values were in the normal range, it didn't have clinical significance even though it was statistically significant. Conclusions:1. There is no apparently difference between HB clinical staging and the AFP level. No relevance between tumor volume and AFP level. Comparisons among any of the three pathological HB types with AFP level had no statistical significance.2. TACE could be used as a kind of preoperative treatments for huge unresectable hepatoblastoma, as it can help lower the HB children's AFP level and reduce the tumor volume, bring chances for surgical resection.3. TACE can also help HB children with nutrition condition, increase their tolerance of surgery and improve the prognosis.4. TACE is a safe effective treatment for HB as the liver, kidney and cardiac toxicity of it is obviously less than systemic chemotherapy. |
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