title: Chemotherapy for suspected hepatoblastoma without efforts at surgical resection is a bad practice.
abstract: BACKGROUND
  US and European practices differ with respect to treating hepatoblastoma (HB). Should chemotherapy be given prior to resection in all cases, and even without biopsy confirmation (SIOPEL)?
  
  
  RESULTS
  US data indicate that 40% of HBs are primarily resectable with no operative mortality and that those with pure fetal histology and low mitotic rate do not require toxic chemotherapy. They also suggest that those with a significant fraction of small undifferentiated cells do not respond to otherwise effective chemotherapy. Both US and European studies report a significant error rate in the clinical and imaging diagnosis of HB.
  
  
  CONCLUSIONS
  Although only 6.5% of confirmed HBs fall into categories that would be managed differently by US standards, there is no justification for denying those patients a more appropriate treatment nor should the 6-10% of cases that are misdiagnosed as HB be treated incorrectly.
authors.affiliation: Department of Pathology, Texas Children's Hospital, Houston, Texas 77030, USA. finegold@bcm.tmc.edu
authors.forename: Milton J
authors.initials: MJ
authors.lastname: Finegold
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols; D005060:Europe; D018197:Hepatoblastoma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D014481:United States