Children with inoperable liver cancer who have not responded to standard chemotherapy have few options. Until now. Our highly promising research—with 10 years of follow-up—suggests that a minimally invasive treatment may prevent the progression of liver tumors and help children alive long enough and become healthy enough to receive life-saving liver transplants.
Last year in the U.S. approximately 15,000 pediatric patients were hospitalized for chronic liver diseases. Approximately 90% of primary liver tumors in children aged 12 to 18 years present in advanced stages and more than 70% of these children will die within five years after diagnosis.
Minimally-invasive treatment offers hope
This treatment—transcatheter arterial chemoembolization or TACE—has traditionally been used on adults, but our team’s research, which we’re presenting at the Society of Interventional Radiology’s 2016 Annual Scientific Meeting, is the first to demonstrate remarkable benefits and survival rates for children.
TACE involves the targeted injection of tiny particles that slow or stop the tumor’s blood supply—shrinking or even killing it off. Often the particles are coated with anti-cancer drugs for an added assault on the tumor. Using imaging for guidance, the interventional radiologist threads a tiny catheter up the femoral artery into the blood vessels supplying the liver tumor. The embolic agents keep the chemotherapy drug in the tumor by blocking the flow to other areas of the body. This allows for a higher dose of targeted chemotherapy to be used because less of the drug is able to circulate to the body’s healthy cells. Because of this precise targeting, we believe TACE is a better option for children compared to traditional, systemic chemotherapy, which often requires multiple rounds of treatment with strong, and often, debilitating drugs that cause significant, painful side-effects and discomfort.
Our results from TACE
In our small but significant study, which represents some of the earliest essential outcomes data needed on the treatment of pediatric cancers, our team at Lucile Packard Children’s Hospital at Stanford University conducted a retrospective analysis of eight children, ages 4 to 17, who underwent TACE for inoperable primary liver cancer (hepatocellular carcinoma, or HCC) between August 2005 and February 2013. We evaluated the effectiveness of this treatment through follow-up imaging, lab tests, and clinical evaluation for up to 10 years.
Overall, we found TACE was successful in controlling cancer in these children, preventing progression of their disease and, in some cases, completely eradicating the liver tumors. What’s particularly promising is how significantly the children responded, shrinking their tumors by half on average. Six of the eight children who underwent TACE were healthy enough to receive a liver transplant. Following transplant, 5 of these 6 survived and were still living at the end of the follow-up period.
The children in our study experienced no significant side-effects related to TACE and were able to leave the hospital one day after treatment on average—demonstrating the incredible potential that targeted cancer therapies can offer children suffering from cancer. We can reduce systemic toxicity, reduce hospital stays, increase time spent with loved ones, prolong life, and even possibly cure in the least invasive manner available.
More time for a definitive cure
Based on these results and our clinical experience, children with inoperable liver cancer and their parents now have an exciting and critical treatment option available to them. It looks promising that TACE can be a safe and effective method for managing tumor growth and potentially keeping children alive long enough for a more definitive cure.
This study also has huge potential with the pediatric oncology community as a whole. Children with cancer are not often offered interventional oncology therapies and, despite being well-known oncologic treatments in adult patients, most pediatric oncologists are unaware of what image-guided interventions have to offer.
Because of the conclusions drawn from this study, we believe that TACE represents the best of interventional radiology and medicine in general. A chance to bring together interventional radiologists, transplant surgeons, and other specialists to improve and even save the lives of children suffering from inoperable cancer. The results from this study show this collaborative spirit in action.