RESUMO
OBJECTIVE: To review our experience in the management of children who present with hepatoblastoma. STUDY DESIGN: Thirty patients treated for hepatoblastoma at a single institution were reviewed. RESULTS: Ten patients presented with stage I to stage II disease and underwent resection. Seventeen presented with stage III disease; two underwent initial resection of which one required rescue transplantation. The remaining 15 underwent biopsies, which were followed by chemotherapy. Nine patients had a reduction in tumor size and underwent conventional resection. One required rescue transplantation for residual disease. Five patients underwent primary transplantation for unresectable disease. One patient expired during chemotherapy. Three patients presented with stage IV disease and underwent biopsies, which were followed by chemotherapy. One patient responded but required "rescue" transplantation after conventional resection. Seven patients underwent aggressive conventional resection (trisegmentectomy or central liver resection); three had positive surgical margins and underwent transplantation. One developed recurrent disease. Five-year survival was 82.5% +/- 7.1%. There was no operative mortality during surgical therapy. All transplant recipients were tumor free, but one died from lymphoma 7 years post-transplant. CONCLUSION: Chemotherapy may reduce tumor size, allowing for conventional resection. If aggressive resection is necessary or bi-lobar disease persists, primary transplantation is recommended.
Assuntos
Hepatoblastoma/terapia , Neoplasias Hepáticas/terapia , Adolescente , Criança , Pré-Escolar , Terapia Combinada , Estudos Transversais , Feminino , Hepatoblastoma/tratamento farmacológico , Hepatoblastoma/cirurgia , Humanos , Lactente , Recém-Nascido , Fígado/efeitos dos fármacos , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Masculino , Estadiamento de Neoplasias , Estudos Retrospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
The authors present their experience with the treatment of tuberculosis of the spine in children during the past ten years in Haiti. Two hundred and fifty-three patients under the age of fifteen have been treated. Initial treatment has consisted of bed rest and chemotherapy. Isoniazid and para-aminosalicylic acid in appropriate dose have been continued for two years. Most were begun on streptomycin initially, but this was usually discontinued after two to three months. One hundred and ninety patients had a surgical fusion. Sixteen of these were re-explored for pseudoarthrosis. One patient died postoperatively and one has a persistent pseudarthrosis; the remainder showed solid fusion within four months on a continued postoperative program of bed rest and chemotherapy. Ninety-eight patients had neurological involvment ranging from slight spasticity to total paraplegia. None had any emergency surgery and ninety-two patients recovered with no serious residuum. Of the remaining six all were able to walk although three who has long-standing paraplegia still required crutches anbd braces for ambulation. No laminectomies were done. Many children, even with several vertebrae involved, will not get well on a program of supportive, recumbent therapy with chemotherapy. The authors' indications for surgical fusion now are: (1) failure to heal properly on conservative therapy, (2) increasing deformity during treatment, (3) lumbar destruction likely to impair stability, (4) to ensure immobilization when the follow-up treatment is doubtful. (Au)