Treatment
Treatment for hepatoblastoma depends on the patient's age, health, and medical history, as well as the stage of the disease, and risk stratification. Risk status is determined by stage and tumor characteristics, called histology, based on tumor pathology following surgery when possible. Risk stratification based on this information helps improve health outcomes by identifying those children that require more intensive therapy and minimizing their use when it may it be necessary.
Very Low-Risk - Stage 1 with fetal histology
Treatment will likely be limited to surgery alone
Low-Risk Stage 1 (other histology) or Stage 2 (other histology)
Treatment will include surgery to remove tumor and chemotherapy
Intermediate-Risk Stage 1 or Stage 2 with undifferentiated histology histology or Stage 3
Treatment may include higher-intensity chemotherapy, surgery, or liver transplantation
High-Risk Stage 4 or any Stage with low levels AFP (blood test) at diagnosis
Treatment may include higher-intensity chemotherapy radiation, surgery, or liver transplant
More simply, some patients with Stage 1 disease and favorable tumor types may be treated with surgery alone while others will need higher-intensity treatment accordingly in order to cure their disease and lower their risk of cancer recurring.
Here are some of the procedures most commonly used to treat hepatoblastoma:
Watchful waiting
In some cases, treatment will not be initiated (or will not resume, following a treatment course) until symptoms develop or increase in severity.
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Chemoembolization and Stem Cell Transplant
Chemotherapy is the use of drugs to target rapidly growing cells to destroy cancer cells. Chemotherapy is the best treatment option for patients whose tumors cannot be removed by surgery. Chemotherapy may also be used prior to surgery to shrink the tumor and allow safer surgery. Chemotherapy is usually injected into the veins or taken orally. The doctor may recommend a form of chemotherapy known as hepatic artery infusion. In this procedure, the doctor uses a catheter to inject chemotherapy drugs directly into the hepatic artery. This procedure delivers chemotherapy more directly to the tumor and reduces side effects. In this procedure, the doctor may also inject small particles through the catheter, in order block the flow of blood to the liver. This procedure, called chemoembolization, prevents the tumor from getting the oxygen and nutrients it needs to grow and traps the chemotherapy drug near the tumor. Some patients require intensive, high-dose chemotherapy. In those cases, stem cells can be collected from the patient’s blood or bone marrow prior to treatment and transfused back to them after treatment to “rescue” their bone marrow.
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Partial hepatectomy
Partial hepatectomy and liver transplantation are the treatments that currently have the best possibility of curing liver cancer. The operation removes only the cancerous area of the liver, leaving the remaining part of the liver. In order to have a partial hepatectomy, the patient must have enough healthy liver to function on its own. Surgery may not be an option for some patients who have a tumor close to the liver’s arteries, veins or bile ducts. A partial hepatectomy is considered the best treatment option available for patients with localized resectable cancer. Chemotherapy may be used prior to surgery in many cases.
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Liver transplantation
A liver transplantation removes all of the liver (total hepatectomy) and replaces it with a healthy liver from an organ donor. This may be indicated when large tumors cannot be safely removed. Your team may recommend chemotherapy at the beginning of treatment as an attempt to shrink large tumors. This may change the ability of the tumor to be safely removed by surgery in some cases. Liver transplantation is indicated for large tumors where resection requires total liver resection.
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Ablation
Ablation uses high-energy radio or microwaves to attack tumors. A thin, needle-like probe is placed into the tumor and releases radio or microwaves. This current then heats the tumor and kills the cancer cells.
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Radiation Therapy
Radiation therapy uses powerful radiation waves to shrink or kill an existing tumor. External radiation directs strong beams of energy at the tumor from outside the body. Internal radiation inserts radioactive substances into the body via needles or catheters. The doctor may also recommend a newer procedure called radioembolization, which combines radiation therapy with tumor embolization. In this procedure, the small particles that are injected into the hepatic artery near the tumor release radiation for several days.
Intensity-modulated radiotherapy (IMRT)
Intensity modulated radiotherapy (IMRT) uses even more X-ray beams and beam angles to permit variations in the dose pattern so that the tumor will receive a higher total dose than the normal tissues.
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Proton beam radiation therapy
Proton therapy is an advanced type of radiation therapy that uses “protons” rather than X-ray “photons” to deliver radiation to the tumor. In conventional radiotherapy, the photon beams can deposit radiation and damage healthy cells as they pass through the body. Proton therapy deposits most of the radiation directly at the tumor site, resulting in less damage to healthy tissue and fewer side-effects.
- Please see Understanding Proton Therapy to learn more.
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Targeted Therapy
Targeted therapy is a relatively new type of treatment that works in two ways. Some types of targeted therapy block proteins on the surface of cancer cells that cause the cancer to grow more aggressively. Other types attack the process of angiogenesis, which tumors use to create new blood vessels to support their growth. Targeted therapy for liver cancer works in both ways to destroy the tumor.
Clinical Trials
Clinical trials are research studies to determine the safety and or effectiveness of new treatments. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
