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Treatment of infantile hepatoblastoma and related complications.

Hepatorblastoma is an uncommon childhood malignant tumor of hepatic origin and recent progress of treatment strategy resulted in improved prognosis of patients with hepatoblastoma. Although patients within one year of age were considered to have better prognosis than those over that age, the treatment related deaths have been reported to be the only cause of the treatment failure of the infantile hepatoblastoma. We have successfully treated 4 infants including one with spontaneous rupture and the other with recurrence. Treatment protocol was preoperative chemotherapy using cisplatin and THP-ADR, doses of which were modified according to the age, with optional radiological interventions followed by resection of the primary tumor. This report would describe their clinical courses and experienced side effects of the treatment in order to demonstrate its risk. Trans-arterial embolizations were beneficial to stop bleeding due to rupture and to reduce intraoperative blood loss. In spite of dose modifications high hematological side effects were inevitable and cisplatn-induced hearing loss persisted in one case. In conclusion, for small infants with hepatoblastoma, controlling the inevitable side effects and active but strategic surgical and radiological interventions are essential for successful treatment.