Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2022; 10(19): 6437-6445
Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6437
Neoadjuvant transcatheter arterial chemoembolization and systemic chemotherapy for the treatment of undifferentiated embryonal sarcoma of the liver in children
Min He, Jia-Bin Cai, Can Lai, Jun-Qing Mao, Jie-Ni Xiong, Zhong-Hai Guan, Lin-Jie Li, Qiang Shu, Mei-Dan Ying, Jin-Hu Wang
Min He, Jia-Bin Cai, Jun-Qing Mao, Jie-Ni Xiong, Zhong-Hai Guan, Lin-Jie Li, Qiang Shu, Jin-Hu Wang, Department of Surgical Oncology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang Province, China
Can Lai, Department of Radiology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang Province, China
Mei-Dan Ying, Cancer Center, Zhejiang University, Hangzhou 310058, Zhejiang Province, China
Author contributions: All authors contributed equally to this work; Wang JH was the guarantor and designed the study; He M drafted the initial manuscript; Wang JH and Ying MD helped to review the literature; Lai C and Wang JH conducted the TACE process; Mao JQ and Li LJ were the oncologists who treated the patient; Wang JH, He M, Cai JB, Xiong JN, Guan ZH and Shu Q were the surgeons who treated the patient; all authors issued final approval for the version to submitted.
Supported by Youth Program of Natural Science Foundation of Zhejiang Province, No. LQ20H160027; and National Natural Science Foundation of China, No. U20A20137.
Institutional review board statement: The study was reviewed and approved by the Children’s Hospital, Zhejiang University School of Medicine Institutional Review Board, No. 2021-IRB-252.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Hu Wang, MD, PhD, Chief Doctor, Director, Surgical Oncologist, Department of Surgical Oncology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No. 3333 Binsheng Road, Hangzhou 310052, Zhejiang Province, China. wjh@zju.edu.cn
Received: November 11, 2021
Peer-review started: November 11, 2021
First decision: March 3, 2022
Revised: March 23, 2022
Accepted: May 16, 2022
Article in press: May 16, 2022
Published online: July 6, 2022
Processing time: 225 Days and 2.7 Hours
ARTICLE HIGHLIGHTS
Research background

Undifferentiated embryonal sarcoma of the liver (UESL) is a rare and aggressive mesenchymal tumor in children.Modern multimodal treatment and supportive therapy have improved survival. Complete tumor excision plays the central role in the treatment of UESL.

Research motivation

The prognosis is poor when complete excision of tumor with UESL cannot be achieved. It is imperative to explore new choices for successful operation of UESL in children.

Research objectives

This report aimed to evaluate the efficacy of neoadjuvant therapy (NAT) for UESL and explore a new choice for successful operation of UESL in children.

Research methods

Six patients who were newly diagnosed and unresectable with UESL received NAT and surgery at our center between January 2004 and December 2019 were retrospectively analyzed. The NAT included preoperative transcatheter arterial chemoembolization (TACE) and systemic chemotherapy. Surgical and survival data would be recorded and analyzed.

Research results

The tumor volumes decreased by 18.2%–68.7%, with a mean value of 36% after 1 cycle of NAT (t = 3.524, P = 0.017). Massive tumor necrosis was seen in the pathological examination of the specimen: > 90% necrosis in two, > 50% necrosis in three, and 25% necrosis in 1, with an average percentage of 71.8%. Complete tumor resection was successfully performed in all patients. Preoperative NAT may help complete removal of unresectable UESLs. However, there was no control group due to the small number of cases.

Research conclusions

The present study indicated that the use of NAT effectively reduced tumor volume, cleared tumor margin, and caused massive tumor necrosis. It may provide a promising choice for successful operation of UESL in children.

Research perspectives

Further investigations with a larger cohort and prospective study are needed to compare the efficacy of TACE, systemic chemotherapy and NAT for UESL.