2019 Volume 56 Issue 2 Pages 107-112
The Paediatric Hepatic International Tumour Trial (PHITT) is a collaborative trial involving three major clinical groups running pediatric liver tumor trials. The aim of the PHITT is to build on the cooperative experience of different consortia to undertake four randomized comparisons of groups of patients with tumors (hepatoblastoma (HB) and hepatocellular carcinoma (HCC)). Decision guidelines for surgical intervention are based on the PRETEXT system and established to evaluate whether reducing treatment doses for low-risk patients maintains their excellent EFS and decreases acute and long-term toxicity. Intensification of therapy with the use of novel agents will be evaluated in a high-risk group. A real-time consultation system will be established to help a local team refer their patients with advanced HB/HCC to a transplant team for further treatment. Selection of the appropriate patients for consideration for up-front surgery requires good imaging during diagnosis and a careful radiological review, anticipating clear resection margins especially in areas adjacent to vascular structures (≧1 cm to the middle hepatic vein). Histological confirmation of HB is required except in emergency situations where the patient is too ill to safely undergo a biopsy. Within the trial, a surgical review study will be included to evaluate the surgical treatment of POST-TEXT III and IV HB. Data obtained from this study will be the basis for assessing the optimal surgical approach for these complex tumors. It is expected that the trial will improve the outcomes in patients with advanced HB/HCC.
