This comparison may be done in a randomized study of two treatment arms or by evaluating a single new treatment, comparing the results with those previously obtained with standard therapy. Because of the relative rarity of cancer in children, all children with liver cancer should be considered for entry into a clinical trial. Treatment planning by a multidisciplinary team of cancer specialists with experience treating tumors of childhood is required to determine and implement optimum treatment. Involvement of surgeons with experience in pediatric liver resection is critical. Historically, resection of the primary tumor has been required to cure malignant liver tumors in children.
Preoperative chemotherapy can convert a nonresectable tumor to a resectable one.
Chemotherapy in some cases is able to eradicate pulmonary metastases completely and eliminate multinodular tumor foci in the liver. Chemotherapy has been much more successful in the treatment of hepatoblastoma than in hepatocellular carcinoma. I tumors of purely fetal histology with chemotherapy unless they develop progressive disease, and resection at the time of diagnosis is encouraged for all tumors amenable to resection without undue risk. When possible, resection of areas of locally invasive disease, such as in the diaphragm, and of isolated brain metastasis is recommended. However, there may be a role for radiation therapy in the management of incompletely resected hepatoblastoma.