When Chemo and Surgery Fails, Targeted Radiation Is an Option for Kids With Liver Cancer

Liver cancer, shown in animation of liver

Luckily, primary malignant liver tumors in children are rare. They account for only 1 to 2 percent of all childhood cancers. About two-thirds of these cancers are malignant. The primary malignant tumors include hepatoblastoma (HB), hepatocellular carcinoma (HCC), rhabdomyosarcoma (RMS), angiosarcoma, rhabdoid tumor, undifferentiated sarcoma and a few other more rare cancers. HB is the most common.

The most common treatment is surgery and chemotherapy. However, not all can be treated by surgery and sometimes they do not respond to chemotherapy.

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“When chemotherapy fails, additional treatment options for children with non-surgical liver cancers are limited and not very effective,” stated Allision Aguado, a pediatric interventional radiologist at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del.

Aguado is the lead author of a study published in the journal Pediatric Blood and Cancer that describes a new targeted tumor radiation treatment in these difficult-to-treat cases. She said, “TARE-Y90 has the potential to offer children with the hardest to treat liver cancer a treatment that is less toxic than current options and could facilitate a cure.”

The study was a retrospective review of 10 children between the ages of 2 and 18 years with primary liver cancer. They were treated with TARE-Y90 between January 2011 and April 2017.

All 10 of the patients had been treated with chemotherapy, which was not successful. There were no surgical options, but they did still have some liver function.

The procedure requires specialized training and, as a result, is only performed at a handful of hospitals, including the duPont Hospital for Children. The team there includes Aguado, Stephen Dunn, a liver transplant surgeon, and Howard Katzenstein, a pediatric liver tumor oncologist.

One of the young patients was Blakleigh Camden. (Blakleigh is pronounced Blake-ly). Her mother, Kasi Camden, said in an interview, “It takes a lot for a mother to trust a team of doctors I’ve never met in my entire life. I just remember walking in and seeing her intubated and her eyes and stuff taped, it was very hard. But I knew that Blakleigh was in wonderful hands with the set of doctors there. They were so amazing to us.”

She describes receiving a call from the surgeon, Dr. Katzenstein, when Blakleigh was approved for the procedure. “I got a call from Dr. K, and he said. ‘Are you available to pack your bags and head for Delaware?’ We were like, ‘What for?’ and he said, ‘We’re ready to get the C Monster out of Blackleigh.”

TARE-Y90 is approved by the Food and Drug Administration (FDA) for adults with liver cancer. The technique allows for higher doses of radiation to be delivered directly to the tumor without attacking the normal surrounding tissue.

The technique uses an image-guided catheter to deliver radioactive microbeads directly to the tumor through a small incision in the groin. Each patient in the retrospective study was treated with the technique once or twice and observed overnight before being discharged. Side effects were either non-existent or mild, including fatigue and fever.

Seven of the patients showed temporary disease control. Two more patients had a partial response. One had “a robust response that was able to be bridged to transplant.”

That patient was Blackleigh. Post-transplant, Blackleigh appears to be doing just fine.

The authors suggest the technique should be considered as adjunctive therapy in pediatric patients with unresectable hepatitis malignancies and could potentially be utilized as a bridge to surgical resection or liver transplant. More research is needed to determine the treatment’s efficacy in children and to further identify the cases where patients would benefit.

In a statement, Aguado said, “TARE-Y90 should be considered effective and feasible for children with liver cancers and has the potential to be used earlier in treatment, alongside chemotherapy, to help reduce tumor size to provide better surgical treatment options and improved prognosis. I am fortunate to be part of the Nemours Liver Tumor Treatment Team, working alongside world renowned pediatric liver specialists, Dr. Howard Katzenstein and Dr. Stephen Dunn, to add interventional radiology to help care for children with liver tumors.”

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