[size=6]A 14-year-old boy presents with a liver lesion in segments 2-4 (PRETEXT 2) VFEPR (-) tumor. AFP is elevated. No metastasis is found.

The best next step for this patient is

 

a neoadjuvant chemotherapy

b open liver biopsy

c early transplantation.

d complete, margin negative resection of the tumor.

e core needle biopsies[/size]

D

D

[size=6]A 14-year-old boy presents with a liver lesion in segments 2-4 (PRETEXT 2) VFEPR (-) tumor. AFP is elevated. No metastasis is found.

The best next step for this patient is

 

a neoadjuvant chemotherapy

b open liver biopsy

c early transplantation.

d complete, margin negative resection of the tumor.

e core needle biopsies[/size]

D

D

D

A

correct answer

d complete, margin negative resection of the tumor.

 

Current recommendations for PRETEXT 1 and 2 liver lesions, VFEPR negative is liver resection done without biopsy independent of suspected cell type if the resection can be accomplished with segmentectomy or hemi-hepatectomy with >1 cm margin. [1]

This is supported by the two most recent prospective International Childhood Liver Tumor Strategy Group trials (SIOPEL 2 and 3)[2]. These trials examined whether modified platinum and doxorubicin based chemotherapy increased tumor resectability and improved patient outcomes. The S2 study included 20 patients and 70 were included in S3. Eighty-five patients with hepatocellular carcinoma (HCC) were able to be evaluated, 13 underwent upfront resection and 72 were treated with intensified platinum and doxorubicin based neoadjuvant chemotherapy regimens in order to render the tumors resectable. Twenty-nine (40%) of the 72 patients had an objective response, but only in two patients (three percent) did initially unresectable tumors become resectable with neoadjuvant chemotherapy. Including seven patients who had liver transplants, 34 (40%) of 85 patients had complete resection with negative margins. Overall five-year survival was dismal at 22%, but 18 (63%) of 27 patients survived after margin negative resection, one of seven patients (14%) survived with microscopic residual disease after resection, and two of seven patients (29%) survived after liver transplant. Complete resection was associated with survival (P=0.035).

 

The authors concluded that patients with resectable HCC should undergo upfront resection, that intensified neoadjuvant chemotherapy did not improve the survival in patients with HCC and that liver transplant is a suitable option for patients with unresectable, nonmetastatic HCC and should be considered early after diagnosis.

[size=6]A 14-year-old boy presents with a liver lesion in segments 2-4 (PRETEXT 2) VFEPR (-) tumor. AFP is elevated. No metastasis is found.

The best next step for this patient is

 

a neoadjuvant chemotherapy

b open liver biopsy

c early transplantation.

d complete, margin negative resection of the tumor.

e core needle biopsies[/size]

D