The use of interventional radiology (IR) in the treatment of pediatric solid tumors has markedly increased over the last three decades. However, data on effectiveness of IR-techniques, such as embolization/ablation, are scarce. In this systematic review and meta-analysis, we examined the outcomes of IR-procedures in the treatment of solid tumors in children.
Using a defined search strategy, we searched for studies reporting the use of IR-techniques for pediatric solid tumors from 1980 to 2017. Reports with less than three patients, review, and opinion articles were excluded. The study was conducted under preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We analyzed dichotomous and continuous variables by appropriate statistical methods.
Of 567 articles screened, 21 papers met the inclusion criteria (12 retrospective, 7 prospective, and 2 randomized-control trials). Many of the analyzed papers described relatively small cohorts of patients. IR-guided procedures were mainly rescue procedures to treat primarily unresectable tumors, local recurrences, or metastases. Inclusion/exclusion criteria and success definition were not specified in most reports. Major side effects were documented in 17/286 (6%) infants, while minor side effects were self-limiting in most patients. Six studies had a comparison between tumor embolization (127 infants) to surgery or chemotherapy without IR-procedures (113 controls). The meta-analysis showed lower mortality (16 vs. 47%) and surgical time for resection (206 vs. 250 m), higher 2-year tumor-free survival (82 vs. 36%), and favorable histology in IR group (p < 0.001 for all).
IR-guided techniques are promising in the treatment of pediatric solid tumors. Further prospective (randomized) trials are needed to clarify efficacy.
European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie. 2019 Jun 23 [Epub ahead of print]
Elisa Zambaiti, Alexander Siles Hinojosa, Valentina Montano, Annika Mutanen, Mathilde Glenisson, Sabine Sarnacki, Stephanie Franchi Abella, Daniele Pariente, Luca Pio
Department of Women's and Children's Health, Pediatric Surgery, Universita degli Studi di Padova Dipartimento di Medicina, Padova, Italy., Pediatric Surgery Department, Miguel Servet University Hospital, Zaragoza, Spain., Depatment Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy., Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada., Department of Pediatric Surgery and Urology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Pari (AP-HP), Paris, France., Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Descartes University, Université de Paris, Paris, France., Pediatric Radiology Department, Assistance Publique-Hôpitaux de Pari (AP-HP), Bicêtre Hospital, Le Kremlin-Bicêtre, France.