Without complete excision, primary liver carcinoma in children is fatal. Six children with initially unresectable liver tumors were treated with chemotherapy in an attempt to decrease the size of the tumor. Cisplatin (CDDP) was added to the regular regimen of Adriamycin (ADR), Vincristine (VCR), and/or Cyclophosphamide in 4 cases. There was a marked reduction in tumor size in three cases. Delayed resections of the primary lesions were successfully perfomed in these 3 cases. These 3 patients are alive and well, and off therapy. The other 3 patients did not respond and died of progressive disease. Cisplatin with Adriamycin, or in combination with other agents, has proven effective in hepatoblastoma. There is a large difference in chemotherapeutic effect between histologic types, with a dramatic response in mixed mesenchymal hepatoblastoma, and a poor response in the adult type. This preoperative chemotherapy regimen permits resection of previously unresectable hepatoblastomas at a "second look" operation and reduces the morbidity and mortality of an otherwise extensive operation.
