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Weeda et al. Hepatoma Res 2021;7:43 https://dx.doi.org/10.20517/2394-5079.2021.10 Page 5 of 7

patients died from tumor progression. The median survival time was 21.5 months, and the survival rates at
1 and 2 years were 91.7% and 83.3%, respectively. There is no data on children with HCC. A clinical trial
[35]
investigating feasibility and safety of MR-HIFU was reported by Napoli et al. in 2013. He reported 6 adult
[36]
patients with osteoid osteoma. In 2018, Sharma et al. described their early experience with MR-HIFU
ablation to treat symptomatic benign, locally aggressive, and metastatic tumors in children. Two clinical
trials were designed in Children’s National Medical Center to investigate feasibility and safety of MR-HIFU
ablation in children with osteoid osteoma (NCT02349971, Jan 2015-Oct 2020) and with refractory or
relapsed solid tumors (NCT02076906, Apr 2014-Apr 2021). HIFU seems a promising method that may be
combined with systemically administered thermally sensitive chemotherapy.

DISCUSSION AND CONCLUSION
The mainstay in curative treatment of pediatric HCC is complete resection; this includes transplantation.
Resection with a tumor-negative margin is crucial. In patients with pediatric HCC where there is any doubt
regarding safe resection with a negative margin, early referral for transplant assessment is warranted. Milan
criteria may not apply in this patient group.

Locoregional treatment modalities may serve as palliation in addition to providing options for a bridge to
surgery/transplantation. Worth mentioning here are TACE, TARE-Y90, and SFRA specifically as a valuable
option for small but centrally located or multifocal HCC.

Systemic treatment is indicated for patients diagnosed in advanced stages who are not primarily amenable
for surgical treatment (including liver transplant) or who suffer recurrence, and adjuvant systemic
treatment is indicated for patients with “de novo” HCC. The presently run PHITT trial may have the power
to answer which regimens would best be used in these scenarios and results are eagerly awaited.
Furthermore, ongoing molecular research efforts clarifying aberrance signatures accompanying the diverse
HCC subcategories based on etiology may guide targeted treatment in the future.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and design of the study and performed data acquisition and
interpretation: Weeda VB, Murawski M

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Both authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.