Medical and Pediatric Oncology zyx 18:181-184 (1990) Adriamycin and Cis-platinum Administered by Continuous Infusion Preoperatively in Hepatoblastoma unresectable at Presentation A.M. Langevin, MD, FRCP(C), A. Pierro, MD, P. Liu, MD, FRCP(C), R.M. Filler, MD, FRCP(C), and M.L. Greenberg, MD, FRCP(C) zyxwv Hepatoblastoma deemed surgically unre- sectable at presentation is fatal unless con- version to resectability is attained. We re- port a series of six consecutive patients, ranging in age from newborn to 5.75 years with hepatoblastoma unresectable at pre- sentation, either because of size of tumor or its anatomical boundaries, or because of metastatic disease. All were treated with preoperative continuous infusions of zyxw cis- platinum and Adriamycin. All achieved resect- ability, and there was only one operative death. The five surviving patients are alive and free of disease off therapy. Potential benefit may ac- crue from preoperative chemotherapy in most cases of hepatoblastorna. 1 Key words: liver tumors, neoadjuvant chemotherapy, surgical resection INTRODUCTION Long-term survival of children with hepatoblastoma depends on complete surgical resection of the tumor. The addition of adjuvant chemotherapy has increased the sur- vival rate to more than 90% for totally resected tumors compared with 35% when surgery is the only treatment deployed [I]. Unfortunately, at presentation, more than 50% of patients will have tumors that are unresectable for technical reasons [2]. Attempts have been made to convert unresectable tumors to resectable ones em- ploying radiotherapy zyxwvutsrq [3] and several chemotherapeutic agents, given both systemically and intra-arterially [ 1- 91. Of these agents, Adriamycin (ADR), used alone or in combination [ 1,5,9], and cis-platinum (C-DDP) [8] have demonstrated clinical efficacy in reducing tumor size. Quinn et al. [9] have reported good results when these two drugs were given in combination. Over the past 2 years, patients with unresectable he- patoblastoma seen at our institution were treated with a combination of ADR and C-DDP, both given by contin- uous infusion in an attempt to increase tumor cell kill and minimize toxicity. Our experience is reported herein. pathologic specimens were reviewed and constitute the material of this study. Median age at presentation was 17.5 months (0 to 5.75 years). Clinical findings are shown in Table I. Clinical and radiological investigations are summarized in Table 11. Tumors were judged to be unresectable because of involvement of both lobes and lung metastases in one patient, definite involvement of both lobes in one patient, and massive tumor size in four patients. All except one patient had a closed needle bi- opsy. Tumor histology was as follows: pure fetal in three patients, pure embryonal in one, and mixed in two pa- tients. Treatment As soon as the pathologic diagnosis was confirmed, central venous lines were inserted and chemotherapy was commenced. All patients received ADR 25 mg/m2/day x 3 days by continuous infusion via the central line and C-DDP 20 mg/m2/day in normal saline X zyx 5 days, also by continuous infusion via a peripheral intravenous line. Infants weighing less than 10 kg received their chemo- MATERIALS AND METHODS Patients From January 1986 to December 3 1, 1987, six con- secutive patients presented at our institution with unre- sectable hepatoblastoma. Medical charts, x-rays, and From the Departments of Pediatrics (A.M.L., M.L.G.), Surgery (A.P., R.M.F.) and Radiology (P.L.), The Hospital for Sick Children, Toronto, Canada. Address reprint requests to M.L. Greenberg, M.D., Director, Clinical Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1x8. Canada. zyxw 0 1990 Wiley-Liss, Inc.