Hepatic metastatic disease in pediatric and adolescent solid tumors

Abstract

The management of hepatic metastatic disease from solid tumors in adults has been extensively described and resection of metastatic liver lesions from colorectal adenocarcinoma, renal adenocarcinoma, breast cancer, testicular cancer, and neuroendocrine tumors (NET) have demonstrated therapeutic benefits in select patients. However, there are few reports in the literature on the management of hepatic metastatic disease in the pediatric and adolescent populations and the effectiveness of hepatic metastasectomy. This may be due to the much lower incidence of pediatric malignancies and the higher chemosensitivity of childhood tumors which make hepatic metastasectomy less likely to be required. We review liver involvement with metastatic disease from the main pediatric solid tumors, including neuroblastoma and Wilms tumor focusing on the management and treatment options. We also review other solid malignant tumors which may have liver metastases including germ cell tumors, gastrointestinal stromal tumors, osteosarcoma, desmoplastic small round cell tumors and NET. However, these histological subtypes are so rare in the pediatric and adolescent populations that the exact incidence and best management of hepatic metastatic disease are unknown and can only be extrapolated from adult series.

Keywords: Hepatic metastatic disease; Neuroblastoma; Pediatric and adolescent solid tumors; Wilms tumor.

Figure 1

Hepatic involvement from (A) stage 4S vs (B) stage 4 neuroblastoma. Primary neuroblastoma (arrowhead).

Figure 2

Patient with stage 3 favourable histology Wilms tumor who recurred eight years after therapy with an isolated liver metastasis. As part of the therapy for this disease recurrence, he underwent right hepatectomy and is currently disease free six years later.