Combination chemotherapy plays several roles in the management of hepatoma:
1. Adjuvant therapy for patients who have undergone complete resection, because its use improves disease-free survival
2. Preoperative therapy for patients who have initial unresectable disease to shrink the primary tumor
3. Palliative therapy for patients with metastatic disease at diagnosis.
Table 24-17 lists three commonly used chemotherapy regimens for childhood hepatoma. Regimen 2 has recently been shown to be as effective as regimen 1 with an equivalent survival. Regimen 2 eliminates the use of anthracycline and has minimal toxicity.
Radiotherapy is not curative for intrahepatic disease because the effective tumor dose exceeds hepatic tolerance. However, radiotherapy may have value in promoting shrinkage of unresectable disease or microscopic residual disease. Radiation dosages used to treat hepatic tumors have ranged from 1200 to 2000 cGy. Occasionally, higher doses to localized areas of tumor have been associated with tumor regression. Radiotherapy immediately after hepatic resection will limit hepatic regeneration.
The only patients who have a reasonable chance of cure are those in whom complete resection can be achieved. Every attempt should be made to resect the primary intrahepatic tumor, even if this requires en bloc resection of contiguous structures.
In patients in whom a complete resection is initially performed, adjuvant chemotherapy should be administered. In patients in whom a complete resection is
Table 24-17. Various Combination Chemotherapy Regimens for Hepatomas
Regimen 1 (every 3-4 weeks)
Adriamycin 25 mg/m2/day x3 continuous infusion by central line: Cisplatin 20 mg/m2/day x5 days continuous infusion, days 0-4 (6 cycles of chemotherapy)
Patients less than 10 kg receive chemotherapy according to weight: Adriamycin 0.83 mg/kg x3 days; cisplatin 0.66 mg/kg/day for 5 days (6 cycles of chemotherapy)
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