• Liver Tumor Program

    Dana-Farber/Boston Children's treats all primary liver tumors occurring in children and young adults. The two most common types of liver tumors are hepatoblastoma and hepatocellular carcinoma, though there are additional rare malignant tumors, benign lesions, and vascular tumors that can occur in the liver. We care for both newly diagnosed liver cancer and for children with relapsed disease.

    We have some of the most experienced pediatric liver cancer oncologists and surgeons in the world, as well as internationally recognized pediatric subspecialists who use sophisticated technology and therapies to maximize outcomes for our patients.

    How We Diagnose Liver Tumors

    In addition to a complete physical examination and medical history, our doctors use a variety of tests to diagnose liver cancer in children. These tests range from blood laboratories (to assess organ function and measure proteins excreted by the tumors) to advanced imaging studies (ultrasound, computerized tomography, and magnetic resonance imaging). Ultimately, the diagnosis is confirmed by tumor biopsy.

    Obtaining a correct diagnosis is a crucial first step in making sure your child receives the most appropriate treatment. Because liver pathology is complicated, liver tumors are sometimes misdiagnosed. For instance, hepatocellular carcinoma may be misdiagnosed as hepatoblastoma. Dana-Farber/Boston Children's has one of the largest, most sophisticated pathology services in the country. Our board-certified pediatric pathologists have further specialization in a variety of forms of cancer, with particular expertise in rare pediatric tumors.

    How We Treat Liver Cancer

    Because the diagnosis of liver cancer in children is rare, the treatment of each child is individualized and complex. Treatment requires thoughtful decision-making by a team of individuals with a high level of expertise in oncologic, surgical, and interventional care at a center with vast experience treating these tumors. At Dana-Farber/Boston Children’s, we offer cutting-edge care delivered by a team of collaborative experts with deep experience in their fields.

    Oncology

    In rare instances, pediatric liver tumors can be treated with surgery alone, though the majority of cases will require treatment with chemotherapy or other medications either prior to or following surgery. While hepatoblastoma is remarkably responsive to chemotherapy, only a fraction of hepatocellular carcinomas will respond to this therapy.

    For patients with a new diagnosis of hepatoblastoma or hepatocellular carcinoma, we offer enrollment in the most recent collaborative Children’s Oncology Group consortium trial. Two of our physicians – Allison O’Neill, MD and Christopher Weldon, MD, PhD – were actively involved in developing the current international liver tumor trial entitled PHITT: Pediatric Hepatic Malignancy International Therapeutic Trial. This trial will study approaches to reducing treatment intensity for patients with low-risk disease and will also collect and analyze tumor samples from enrolled patients with the hopes of identifying unique therapies.

    For patients with recurrent hepatoblastoma or hepatocellular carcinoma unresponsive to chemotherapy, we have expertise in the use of:

    • antiangiogenic drugs that interfere with the formation of blood vessels
    • targeted agents that interrupt genetic pathways important for tumor growth
    • immunotherapies that capitalize on the patient’s own immune system

    Our use of interventional techniques to deliver drugs directly to the tumor, and experimental therapeutics to provide novel therapies for advanced disease, set us apart from other programs. We also work in concert with a comprehensive radiation oncology program paired with Brigham and Women’s Hospital, and we offer remote consultations through online second opinion platforms such as Grand Rounds and MOREHealth, thereby reaching patients and families at every corner of the globe.

    Surgery

    In addition to medical therapies, surgery is a necessary component of therapy for all liver tumors. To remove a tumor, surgery may involve removing a portion of the liver (partial hepatectomy), or in rare cases, the entire liver (total hepatectomy), replacing it with a liver from an organ donor (liver transplant).

    Surgery involving the liver is extraordinarily complex and requires a surgeon well-versed in this specialized skill. Because liver tumors in children are rare, few surgeons see enough cases to develop extensive expertise. At Dana-Farber/Boston Children’s, our experts specialize in pediatric liver surgery and have successfully performed some of the most complicated liver operations in children. In seamless collaboration with Boston Children’s, the nation’s top-ranked pediatric hospital, we have built a multidisciplinary team for each patient that draws from our oncology, pediatric gastroenterology, interventional radiology, and surgery divisions.

    Patients around the world choose us for their care. Within the past 15 years, our surgeons have performed nearly 50 liver tumor surgeries, a large number given the rarity of these conditions. Since 2001, we have performed 25 liver transplants and 3 multivisceral (multiple organs) transplants for patients with liver tumors. Our advanced capabilities include:

    • autotransplantation - removing the liver to allow dissection of an advanced tumor from the organ, while replacing the remaining liver following removal of the cancer
    • blood vessel or bile-duct reconstruction
    • heart-lung bypass to remove a tumor that has grown into the heart

    Very few sites can offer conventional surgery, transplant, and the ancillary staff necessary to care for unique complex cases.

    Interventional Radiology

    Interventional radiology refers to techniques that allow delivery of therapy directly to the site of disease. In the case of liver tumors, interventional procedures can involve:

    • radiofrequency ablation - destruction of tumors through direct delivery of heat
    • transarterial embolization - disruption of the blood supply to the tumor
    • transarterial chemoembolization - direct delivery of chemotherapy to the tumor
    • Yttrium-90 - direct delivery of a radioactive compound to the tumor

    These measures can prevent tumors from growing and/or shrink tumors as a bridge to surgery. While these procedures have been available to adult patients for years, they have yet to be routinely utilized for pediatric liver tumor patients. We are one of the few pediatric sites in the United States to be able to offer these specialized therapeutic approaches to our patients.

    Our Liver Cancer Treatment Specialists

    Dana-Farber/Boston Children's patients are treated by physician scientists who are unparalleled in their training and experience. The depth and breadth of our expertise allows us to assemble a team of specialists to meet the specific needs of each patient.

    At the core of each treatment team are medical oncologists who specialize in liver cancer. From there, we draw experts from two world-class institutions, combining Dana-Farber’s cancer specialization with the wide-ranging abilities of Boston Children’s, the nation’s top-ranked pediatric hospital. Depending on your child’s diagnosis, he or she may be treated by surgeons, hepatologists (liver specialists), radiation oncologists, interventional radiologists, pathologists, or transplant physicians.

    Allison O’Neill, MD, Medical Director of the Liver Tumor Program, has worked to design a unique multidisciplinary, collaborative approach to the treatment of pediatric liver tumor patients to assure delivery of cutting-edge therapies, procedures, and research efforts. She specializes in the treatment of all liver tumors and has a particular research interest in advancing the care of pediatric hepatocellular carcinomas.

    One of our surgeons, Heung Bae Kim, MD, is one of only a few surgeons in the nation who are dual-trained in pediatric general surgery and in liver transplantation – which means he brings to your child a virtually unparalleled expertise in pediatric liver tumor surgery.

    We round out our treatment team with experts who help your child prepare for life during and after treatment, including psychiatrists and psychologists, child-life specialists, social workers, nutritionists and school specialists.

    We attract physicians who are international leaders in their specialties. Many of our doctors are also active researchers, so our patients have access to the very best, most up-to-date treatments available.

    Learn more about the Liver Tumor Treatment Team.

    Liver Cancer Research and Clinical Trials

    Our clinical research program offers unique access to clinical trials in which children can receive the most up-to-date liver cancer treatments. A major focus of our research program is the rapid translation of scientific discoveries from the laboratory to the bedside to benefit patients. Through this research, our physicians work to improve therapeutic approaches and outcomes for hard-to-treat tumors. This includes discoveries from our pediatric laboratories along with close collaboration with adult colleagues and those in the pharmaceutical industry.

    Through this research, our physicians work to improve therapeutic approaches and continually improve outcomes. We have a prospective liver tumor registry which allows us to collect important clinical information from our patients, assisting in the care of patients we treat years down the road. We offer genomic tumor profiling for every patient we see, allowing us to study relevant genetic pathways in large cohorts of children with these rare diseases. We hope to offer this option remotely for patients, going forward.

    Our new molecular pathology laboratory will allow the rapid identification of rare liver tumors at the time of diagnosis while working to discover new genetic patterns useful for diagnosis and treatment in the future. Khashayar Vakili, MD, transplant surgeon and preclinical researcher, is investigating how to grow liver tumors in mouse models, while other laboratory researchers seek to grow liver tumor cells in culture dishes and zebrafish models. This will allow novel drug testing that can inform additional therapies for hard-to-treat tumors.

  • Top Ranked for Cancer Care

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