Treatment Outcome of Childhood Hepatoblastoma: a Single Centre Experience in Bangladesh

Background: Hepatoblastoma is a rare malignant liver tumor that occurs almost exclusively in childhood. Although surgical resection is the foundation of curative therapy in hepatoblastoma, with the use of effective neoadjuvant and adjuvant chemotherapy, the survival of patients with hepatoblastoma has improved significantly. Objective: To evaluate the clinical characteristics and treatment outcome of childhood hepatoblastoma treated at a tertiary care center in Bangladesh. Methods: This observational study was conducted in the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University, Bangladesh. The patient’s data were analyzed for clinical characteristics, treatment modalities, and survival outcomes. Result: Twenty-four patients who were treated for Hepatoblastoma at our center were included in the study. Sixteen (66.5%) of them were male and M:F = 3:1 . The median age of presentation was 2.8 years, and 62.5% of patients were below 3 years of age. The median time of diagnosis after onset of symptoms was 8 months. An abdominal mass (90%) and abdominal pain (59.8%) were the most common presenting symptoms. The serum alpha-fetoprotein at the time of initial evaluation was raised in 96% of patients. The fetal histology (62.5%%) was the most common histological subtype. Two (8.4%), 7 (29 %), 8 (33.6%), and 7 (29 %) patients were found to have pre-treatment extent of tumor (PRETEXT) stages I, II, III, and IV, respectively. Seventeen (71 %) children were classified as standard risk, and 7 (29%) children as high risk. Complete resection of the primary tumor was possible in 11 (46%) patients. Out of the studied patients 12.5% developed relapse. Five-year overall survival was 66.6% and event-free survival was 58.3%. Conclusion: The treatment outcome of hepatoblastoma at our center is comparable to other countries. The feasibility of all modalities of treatment, like liver transplantation in children, may improve the outcome.