Late Effects After Treatment of Hepatoblastoma and Hepatocellular Carcinoma in Childhood and Adolescents

Hepatoblastoma and hepatocellular carcinoma are the most common malignant liver diseases in childhood. Although complete resection is the cornerstone of the treatment concept, nearly all patients with hepatoblastoma receive pre- and postoperative chemotherapy. The most important cytostatic drug is cisplatin given either alone or in combination with carboplatin, doxorubicin, vincristine, etoposide, ifosfamide, 5-fluorouracil and/or irinotecan. Treating hepatocellular carcinoma remains more difficult since this tumour is rather chemotherapy-resistant, so that surgery becomes even more important. However, in children and adolescents, less than 20% are considered eligible for initial complete resection. Currently, the paediatric HCC community accepted cisplatin/doxorubicin as standard chemotherapy now combined with sorafenib. The role of GemOx (gemcitabine, oxaliplatin) is evaluated in the currently active PHITT (Paediatric Hepatic International Tumour Trial) study. The long-term investigations must therefore focus on ototoxicity, nephrotoxicity (with an impaired glomerular filtration rate and renal magnesium loss) and cardiotoxicity (when doxorubicin was given). Patients who do not receive chemotherapy can be followed up only for disease progression (physical examination, AFP in serum, tumour assessment and assessment of lung metastases) for a minimum of 5 years after diagnosis.