| Objective:To compare the treatment outcomes of chemotherapy plus high-intensity focused ultrasound (HIFU) ablation versus chemotherapy alone in children with stage Ⅲ and IV hepatoblastoma.Methods:Retrospective analysis were conducted for the clinical data of 30 cases of stages Ⅲ and IV hepatoblastoma form August 2007 to June 2013. Re-evaluation of tumor resectablility after treamt was made foe chemotherapy plus HIFU ablation (n=12) versus chemotherapy (n=18) And follow-ups were conducted for tumor size, survival, metastasis, recurrence and alpha-fetoprotein.Results:As compared with chemotherapy, Chemotherapy plus HIFU ablation could significantly improve the response rate (P=0.002, Fisher’s exact test) and surgical resection rate (P=0.024, Fisher’s exact test). Neutropenia (P=0.13), cardiac & renal toxicity (P=0.36) and other side effects showed no inter-group difference.Tumor response and prognosis (P=0.001, Fisher’s exact test) and disease progression (P=0.018,Fisher’s exact test) had significant differences. A higher mortality rate was found in chemotherapy patients without surgery than chemotherapy plus HIFU group(P=0.001,Fisher’s exact test). Recurrence or death showed no significant inter-group difference. In chemotherapy plus HIFU ablation group, The AFP before and after treatment was(>363000 ng/mL,0.27 ng/mL) and diameter of tumor (112 mm,27 mm). In chemotherapy group, AFP (>363000 ng/mL,219000 ng/mL), tumor diameter(119 mm,84 mm). For chemotherapy plus HIFU ablation group, median survival time was 45(16-62) months,1-year survival rate 100%,3-year survival rate 83.3%, 5-year survival rate 16.7% and mortality rate 16.7%; For chemotherapy group, median survival time was 18 months,1-year survival rate 83.3%, 3-year survival 5.6% and mortality rate 55.5%. Chemotherapy plus HIFU ablation could significantly improve survival rate and prolong survival time.Conclusions:Chemotherapy plus HIFU treatment may significantly improve remission rate, boost surgical resectability rate and prolong survival for children with unresectable tumor. |
