Abstract

Background:We would like to present two patients in our hospital for hepatoblastoma,both with late relapse diagnosed.Case Report:Patient No 1.3 8/12-year old girl was treated for liver left lobe hepatoblastoma at the age of 15 months.The level of AFP before the treatment ’s beginning was 428 400 JU/ml.The tumor was situated in the whole epigastric region and was also palpable in pelvis.The patient was qualified to the chemotherapy according to SIOPEL protocol.She received 3 course of treatment:1CDDP-80 mg/sqm,and 3 courses of PLADO (ADM/CDDP).AFP decreased to the level of 199.76 IU/ml. Afterwards the surgical procedure of the tumor ’s resection was perfomed. Histological examination has proved total tumor necrosis;alive neoplastic cells were found only in satellite module and in the lymph node.Application of 2 course of PLADO followed the operation and led to treatment completion.14 months after the treatment ’s end the local relapse in the left lobe of the liver with increase of AFP to the level of 767,79 was diagnosed. Chemotherapy with high doses of CTX (due to SIOPEL protocol)was introduced.There was no response to this treatment.Therefore chemotherapy was changed –the patient received 1 course of CBDCA/VP-16 –without any response again.Hence the chemotherapy was changed again –2 courses of ADM/CDDP were administred.The level of AFP decreased, which allowed performing a surgical resection of the right liver lobe.Histological examination has proved live neoplastic cells in the whole tumor; neoplastic cells were also present in the blood vessels.Due to this result the treatment was changed again –the patient received combined chemotherapy:CDDP, 5FU,VCR.The girl received 2 courses of this therapy and still is being treated in our hospital. Patient No 2.4-year old girl treated from the age of 12 months or left liver lobe hepatoblastoma.The level of AFP before treatment ’s beginning was 595 000 UI/ml.The tumor was diagnosed as inoperalbc.The patient was qualified to the chemotherapy according to SIOPEL protocol.She received 5 course of CDDP in dose of 80 mg/m 2 and 3 courses of PLADO. AFP level decreased to 4 000 IU/ml.The surgical procedure of the tumor ’s resection was perfomed.Histological examination has proved tumor necrosis in 50%,the operation waw not adical,neoplastic cells were present in blood vessels. Chemotherapy was being continued and the girl received 4 courses of PLADO,what completed the treatment.35 months after the treatment ’s and a relapse in the right lobe of the liver was diagnosed.Additionally metastases in the right lung was suspected.AFP –46 020 IU/ml.Chemotherapy with high doses of CTX according to SIOPEL was administered.After 2 courses there was no response to the reatment.Chemotherapy was changed –the patient received 1 course of CBDCA/VP-16- also without any response.Afterwards chemotherapy with ADM/CDDP according to SIOPEL was administred.A positive response towards treatment has been obtained –AFP decreased to the level of 845 IU/ml.The patient is still treated in our hospital.Conclusions:1.The patient after completed treatment for hepatoblastoma should be observed for the long time because of a high risk of late relapses. 2.If the radicality of surgery procedure is doubtful it seems to be advisable to adhibit local radiotherapy.

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