The Role of IR in Pediatric Liver Cancer

Michael R. Acord; Allison Aguado; Anne E. Gill

doi:10.1055/s-0045-1811256

Seminars in Interventional Radiology, Table of Contents

Semin intervent Radiol 2025; 42(03): 328-335
DOI: 10.1055/s-0045-1811256

Review Article

The Role of IR in Pediatric Liver Cancer

Authors

Michael R. Acord

¹Primary Children's Medical Center, Division of Interventional Radiology, University of Utah School of Medicine, Salt Lake City, Utah
Allison Aguado

²St. Jude Children's Research Hospital, Division of Interventional Radiology, Memphis, Tennessee
Anne E. Gill

³Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Georgia

⁴Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Georgia

Abstract

Despite the well-defined role of interventional radiology (IR) in the management of adult patients with hepatocellular carcinoma (HCC), the role of IR for pediatric liver tumors is still being established. This is, in part, due to the rarity and heterogeneity of pediatric liver tumors as well as the limited literature supporting liver-directed therapies for children. In addition, hepatoblastoma, the most common primary pediatric liver tumor, carries a good prognosis with current surgical and systemic treatment options directed by well-established clinical trials. Still, a subset of patients will not be amenable to operative treatment, and other pediatric liver tumors, such as HCC, portend a dismal prognosis. These settings offer opportunities for growth of pediatric IR and to provide services that improve the lives of children. The purpose of this article is to review the role of IR in pediatric liver cancer, including biopsy recommendations set forth by current clinical trials, transarterial chemoembolization and radioembolization, and percutaneous ablation.

Keywords

liver cancer - pediatric - interventional radiology - ablation - embolization - biopsy

Full Text

References

References
1 López-Terrada D, Alaggio R, de Dávila MT. et al; Children's Oncology Group Liver Tumor Committee. Towards an international pediatric liver tumor consensus classification: proceedings of the Los Angeles COG liver tumors symposium. Mod Pathol 2014; 27 (03) 472-491
2 Varol Fİ. Pediatric hepatocellular carcinoma. J Gastrointest Cancer 2020; 51 (04) 1169-1175
3 Rees MA, Schooler GR, Chavhan GB. et al. Imaging features of hepatocellular carcinoma in children with and without underlying risk factors. AJR Am J Roentgenol 2022; 219 (04) 647-654
4 Schooler GR, Infante JC, Acord M. et al. Imaging of pediatric liver tumors: a COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 (Suppl. 04) e29965
5 Towbin AJ, Meyers RL, Woodley H. et al. 2017 PRETEXT: radiologic staging system for primary hepatic malignancies of childhood revised for the Paediatric Hepatic International Tumour Trial (PHITT). Pediatr Radiol 2018; 48 (04) 536-554
6 University of Birmingham. Paediatric Hepatic International Tumour Trial. RG_15–114.
7 Ludwig DR, Romberg EK, Fraum TJ, Rohe E, Fowler KJ, Khanna G. Diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS) v2017 in predicting malignant liver lesions in pediatric patients: a preliminary study. Pediatr Radiol 2019; 49 (06) 746-758
8 Kastenberg ZJ, Baertschiger RM, Cuenca AG. et al. Critical elements of pediatric liver cancer surgery. Semin Pediatr Surg 2023; 32 (05) 151340
9 Meyers RL, Tiao G, de Ville de Goyet J, Superina R, Aronson DC. Hepatoblastoma state of the art: pre-treatment extent of disease, surgical resection guidelines and the role of liver transplantation. Curr Opin Pediatr 2014; 26 (01) 29-36
10 Weldon CB, Madenci AL, Tiao GM. et al. Evaluation of the diagnostic biopsy approach for children with hepatoblastoma: a report from the Children's Oncology Group AHEP 0731 liver tumor committee. J Pediatr Surg 2020; 55 (04) 655-659
11 Kastenberg ZJ, Short SS, Riehle KJ. et al. Management of undifferentiated embryonal sarcoma of the liver: A Pediatric Surgical Oncology Research Collaborative study. Pediatr Blood Cancer 2024; 71 (06) e30975
12 Czauderna P, Otte JB, Aronson DC. et al; Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL). Guidelines FOR SURGICAL TREATMENT OF HEPATOBLASTOMA IN THE MODERN ERA–RECOMMENDATIONS FROM the Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL). Eur J Cancer 2005; 41 (07) 1031-1036
13 Sumazin P, Chen Y, Treviño LR. et al. Genomic analysis of hepatoblastoma identifies distinct molecular and prognostic subgroups. Hepatology 2017; 65 (01) 104-121
14 Schoeman S, Escobar F, Kreiger P. et al. Image-guided biopsy for the diagnosis and molecular profiling of hepatoblastoma. Pediatr Blood Cancer 2025; 72 (04) e31575
15 Lungren MP, Towbin AJ, Roebuck DJ. et al. Role of interventional radiology in managing pediatric liver tumors: part 1: endovascular interventions. Pediatr Radiol 2018; 48 (04) 555-564
16 Zhang Y, Solinas A, Cairo S, Evert M, Chen X, Calvisi DF. Molecular mechanisms of hepatoblastoma. Semin Liver Dis 2021; 41 (01) 28-41
17 Katzenstein HM, Malogolowkin MH, Krailo MD. et al. Doxorubicin in combination with cisplatin, 5-flourouracil, and vincristine is feasible and effective in unresectable hepatoblastoma: A Children's Oncology Group study. Cancer 2022; 128 (05) 1057-1065
18 Schooler GR, Squires JH, Alazraki A. et al. Pediatric hepatoblastoma, hepatocellular carcinoma, and other hepatic neoplasms: consensus imaging recommendations from American College of Radiology Pediatric Liver Reporting and Data System (LI-RADS) Working Group. Radiology 2020; 296 (03) 493-497
19 Heran MKS, Marshalleck F, Temple M. et al; Society of Interventional Radiology Standards of Practice Committee and Society of Pediatric Radiology Interventional Radiology Committee. Joint quality improvement guidelines for pediatric arterial access and arteriography: from the Societies of Interventional Radiology and Pediatric Radiology. J Vasc Interv Radiol 2010; 21 (01) 32-43
20 Sueyoshi E, Hayashida T, Sakamoto I, Uetani M. Vascular complications of hepatic artery after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. AJR Am J Roentgenol 2010; 195 (01) 245-251
21 Yus TM, Sarastika HY, Soeprijanto B. Feeding artery characteristics and enhancement patterns of hepatoblastoma patients treated with transarterial chemoembolization (TACE): Digital subtraction angiography evaluation. Narra J 2023; 3 (03) e209
22 Kim T, Shaikh R. Interventional radiology management of pediatric liver tumors. Dig Dis Interv 2024; 08 (02) 130-136
23 Shaikh R, Munoz FG. Endovascular approaches in pediatric interventional oncology. CVIR Endovasc 2021; 4 (01) 2
24 Hirakawa M, Nishie A, Asayama Y. et al. Efficacy of preoperative transcatheter arterial chemoembolization combined with systemic chemotherapy for treatment of unresectable hepatoblastoma in children. Jpn J Radiol 2014; 32 (09) 529-536
25 Weiss KE, Sze DY, Rangaswami AA. et al. Transarterial chemoembolization in children to treat unresectable hepatocellular carcinoma. Pediatr Transplant 2018; 22 (04) e13187
26 Xuewu J, Jianhong L, Xianliang H, Zhongxian C. Combined treatment of hepatoblastoma with transcatheter arterial chemoembolization and surgery. Pediatr Hematol Oncol 2006; 23 (01) 1-9
27 Oue T, Fukuzawa M, Kusafuka T, Kohmoto Y, Okada A, Imura K. Transcatheter arterial chemoembolization in the treatment of hepatoblastoma. J Pediatr Surg 1998; 33 (12) 1771-1775
28 Zhang J, Xu F, Chen K. et al. An effective approach for treating unresectable hepatoblastoma in infants and children: pre-operative transcatheter arterial chemoembolization. Oncol Lett 2013; 6 (03) 850-854
29 West HJ, Jin JO. Transarterial chemoembolization. JAMA Oncol 2015; 1 (08) 1178
30 Li JP, Chu JP, Yang JY, Chen W, Wang Y, Huang YH. Preoperative transcatheter selective arterial chemoembolization in treatment of unresectable hepatoblastoma in infants and children. Cardiovasc Intervent Radiol 2008; 31 (06) 1117-1123
31 Angelico R, Grimaldi C, Saffioti MC, Castellano A, Spada M. Hepatocellular carcinoma in children: hepatic resection and liver transplantation. Transl Gastroenterol Hepatol 2018; 3: 59
32 Knight GM, Gordon AC, Gates V. et al. Evolution of personalized dosimetry for radioembolization of hepatocellular carcinoma. J Vasc Interv Radiol 2023; 34 (07) 1214-1225
33 Aguado A, Ristagno R, Towbin AJ. et al. Transarterial radioembolization with yttrium-90 of unresectable primary hepatic malignancy in children. Pediatr Blood Cancer 2019; 66 (07) e27510
34 Aguado A, Dunn SP, Averill LW. et al. Successful use of transarterial radioembolization with yttrium-90 (TARE-Y90) in two children with hepatoblastoma. Pediatr Blood Cancer 2020; 67 (09) e28421
35 Hawkins CM, Kukreja K, Geller JI, Schatzman C, Ristagno R. Radioembolisation for treatment of pediatric hepatocellular carcinoma. Pediatr Radiol 2013; 43 (07) 876-881
36 Whitlock RS, Loo C, Patel K. et al. Transarterial radioembolization treatment as a bridge to surgical resection in pediatric hepatocellular carcinoma. J Pediatr Hematol Oncol 2021; 43 (08) e1181-e1185
37 Aguado A. Role of interventional radiology in pediatric cancer patients. Curr Oncol Rep 2022; 24 (12) 1731-1740
38 SIOP abstracts. Pediatr Blood Cancer 2020; 67 (S4):
39 Ljuboja D, Weinstein JL, Ahmed M, Sarwar A. Extrahepatic transarterial radioembolization to treat fibrolamellar hepatocellular carcinoma: a case report. Radiol Case Rep 2020; 15 (12) 2613-2616
40 Gómez FM, Aguado A, Barnacle AM, Runge JH, Temple M. Opportunities for interventional radiology in paediatric oncology. EJC Paediatr Oncol 2024; 3: 100139
41 Goldberg SN, Grassi CJ, Cardella JF. et al; Society of Interventional Radiology Technology Assessment Committee. Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 2005; 16 (06) 765-778
42 Spiliotis AE, Gäbelein G, Holländer S, Scherber PR, Glanemann M, Patel B. Microwave ablation compared with radiofrequency ablation for the treatment of liver cancer: a systematic review and meta-analysis. Radiol Oncol 2021; 55 (03) 247-258
43 Long H, Wu W, Zhou L, Shen H, Xie X, Liu B. Radiofrequency ablation for pediatric recurrent hepatocellular carcinoma: a single-center experience. BMC Med Imaging 2023; 23 (01) 202
44 van Laarhoven S, van Baren R, Tamminga RYJ, de Jong KP. Radiofrequency ablation in the treatment of liver tumors in children. J Pediatr Surg 2012; 47 (03) e7-e12
45 Hesh CA, Gill AE, Soler Rodriguez D, Clifton MS, Mitchell S, Hawkins CM. Percutaneous image-guided microwave ablation as primary therapy for pretext II hepatoblastoma. Pediatr Blood Cancer 2020; 67 (10) e28641
46 Ye J, Shu Q, Li M, Jiang TA. Percutaneous radiofrequency ablation for treatment of hepatoblastoma recurrence. Pediatr Radiol 2008; 38 (09) 1021-1023
47 Chen ST, Han ZY, Ling P. et al. Percutaneous thermal ablation versus open liver resection for recurrent hepatoblastoma: a retrospective study. Int J Hyperthermia 2021; 38 (01) 1086-1091
48 Sparchez Z, Mocan T, Radu P. et al. Microwave ablation in the treatment of liver tumors. A better tool or simply more power?. Med Ultrason 2020; 22 (04) 451-460
49 Song Y, Wu M, Zhou R, Zhao P, Mao D. Application and evaluation of hydrodissection in microwave ablation of liver tumours in difficult locations. Front Oncol 2023; 13: 1298757
50 Marrero JA, Kulik LM, Sirlin CB. et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2018; 68 (02) 723-750
51 Kolck J, Schulze D, Brönnimann M. et al. Percutaneous cryoablation in the liver: a meta-analysis and review of safety with a focus on incidence of cryoshock and major complications. Cardiovasc Intervent Radiol 2024; 47 (11) 1471-1484
52 Chehab MA, Thakor AS, Tulin-Silver S. et al. Adult and pediatric antibiotic prophylaxis during vascular and IR procedures: a Society of Interventional Radiology Practice Parameter Update endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol 2018; 29 (11) 1483-1501.e2
53 Bouda D, Lagadec M, Alba CG. et al. Imaging review of hepatocellular carcinoma after thermal ablation: the good, the bad, and the ugly. J Magn Reson Imaging 2016; 44 (05) 1070-1090
54 Morin CE, Kolbe AB, Alazraki A. et al. Cancer therapy-related hepatic injury in children: imaging review from the pediatric LI-RADS working group. Radiographics 2023; 43 (09) e230007