Outcome Of Different Combination Chemotherapy Regimens For Hepatoblastoma

Objective To investigate the outcome of patients with hepatoblastoma(HB) treated with different chemotherapy regimens.Methods We summarized clinical data of 26 cases with HB who were treated in our hospital between August 2007 and February 2016. Different chemotherapy regimens were used before and after March 2013. Patients were divided into group A(14 patients treated between August 2007 and March 2013) and group B(12 patients treated between March 2013 and February 2016).Two groups all used chemotherapy combined surgical treatment. Patients were stratified into stageⅠ, Ⅱ, Ⅲ, Ⅳ, according to the images of tumors taken at diagnosis. If feasible, partial hepatectomy(primary or delayed surgery) was then performed; and four to six final courses were given after alpha-fetoprotein(AFP) was decreased to normal value. Patients with stage Ⅰ, Ⅱ, Ⅲ in group A were treated with vincristine(VCR), epirubicin(EPI) and cyclophosphamide(CTX), stage Ⅳtreated with cisplatin(PLA) and EPI. Patients with stage Ⅰ, Ⅱwere treated with PLA, VCR and fluorouracil(5-FU), stage Ⅲ, Ⅳtreated with PLA and EPI. Individualized treatment was given to patients who had Progressive disease(PD), tumor recurrence and severe viscera damage.Results 14 patients in group A had a total 21 courses of preoperative chemotherapy and 54 courses of postoperative chemotherapy. 12 patients in group B had a total 36 courses of preoperative chemotherapy and 59 courses of postoperative chemotherapy. Patients who had resection in group A and B were 13 and 11, respectively; resection rate was 92.9% and 91.7%, respectively. The resection rate was similar(P=0.72). Up to the cutoff date(February 1, 2016), the follow-up time of group A and B was 1-93 months and 2-23 months, respectively; PFS time was 1-93 months and 2-23 months, respectively; median PFS time and OS time was 9 months, 13 months and 18.5 months,18.5 months, respectively. Group B(83.3%) had a higher 1 year PFS rate than group A(35.7%)(P=0.21). Also, group B(83.3%) had higher 1year OS rate than group A(50%)(P=0.42). Different stages two groups of data pairwise comparison had been made. Both of groups of patients had different degrees of bone marrow suppression after chemotherapy.Conclusions PLA and EPI, either PLA, VCR and 5-FU was more effective than VCR, EPI and CTX for children with HB; different stages of two groups had pairwise comparison, and there was no difference between the chemotherapies, which may be due to less amount of the data. Yet still need to be proved. The side effects of PLA and EPI, and PLA, VCR and 5-FU were reversible and tolerable.