Journal of Clinical Oncology, Vol 9, 2167-2176, Copyright © 1991 by American Society of Clinical Oncology
Effective treatment of unresectable or metastatic hepatoblastoma with cisplatin and continuous infusion doxorubicin chemotherapy: a report from the Childrens Cancer Study Group
JA Ortega, MD Krailo, JE Haas, DR King, AR Ablin, JJ Quinn, J Feusner, JR Campbell, DA Lloyd and J Cherlow
Children's Hospital of Los Angeles, CA.
The Childrens Cancer Study Group (CCSG) undertook a study (CCG-823F) to
test the feasibility of administering continuous infusion doxorubicin (CI
DOX) and cisplatin (CDDP) in patients with unresectable or incompletely
resected hepatoblastoma (HB) or hepatocellular carcinoma (HCC).
Chemotherapy consisted of CI DOX 20 mg/m2/d for days 1 to 4 and CDDP 100
mg/m2 on day 1 followed by a 21-day rest period. Second-look surgery was
performed after the administration of four chemotherapy courses.
Forty-seven (47) assessable patients were entered on study, 33 with HB and
14 with HCC; of these, 34 (26 HB and eight HCC) completed the initial four
courses of chemotherapy. Of the 26 HB patients, 25 were evaluated as
responding to chemotherapy before the scheduled second-look procedure and
were considered surgically resectable at that time. Surgery was performed
on 22 patients; three patients refused the second-look surgery. Nine
patients had no evidence of residual malignant disease, seven underwent
surgical resection of remaining tumor, four were left with microscopic
residual disease, one had a partial resection with gross tumor left behind,
and one remained unresectable. Nine HCC patients completed four
chemotherapy courses. Eight patients achieved a partial remission and
second-look surgery was attempted on seven. Only two had all malignant
disease removed at the second procedure. Data from 225 courses of
chemotherapy were evaluated for toxicity. Neutropenia (absolute granulocyte
count less than 500/mL) was observed in 68 courses, and five of these
episodes were associated with sepsis. Severe mucositis was documented in 21
courses, and hypomagnesemia (magnesium less than 1.2 mg) was noted in 30
patients. Two patients developed decreased left ventricular shortening
fraction, which resolved when chemotherapy was discontinued. In summary, CI
DOX plus CDDP is a well-tolerated and effective regimen in inducing
surgical resectability in HB patients who are unresectable at diagnosis and
significantly improves survival for this group of patients to 66.6%.
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