title: Defining hepatoblastoma responsiveness to induction therapy as measured by tumor volume and serum alpha-fetoprotein kinetics.
abstract: OBJECTIVE
  Hepatoblastoma is commonly unresectable at presentation, necessitating induction chemotherapy before definitive resection. To refine the paradigm for timing of resection, we questioned whether a plateau in hepatoblastoma responsiveness to neoadjuvant therapy could be detected by calculating tumor volume (TV) and serum alpha-fetoprotein (sAFP) kinetics.
  
  
  METHODS
  To calculate TV and sAFP as measures of treatment responsiveness over time, infants having initially unresectable epithelial-type hepatoblastomas were identified at a single institution (1996-2008). Effects of therapy type, therapy duration, and lobe of liver involvement on TV, sAFP, margin status, and toxicity were analyzed.
  
  
  RESULTS
  Of 24 infants treated for epithelial-type hepatoblastoma during this interval, 5 were resected primarily, and 15 had complete digital films for kinetics analysis. Both TV and sAFP decreased dramatically over time (P < .0001). No statistically significant difference in mean TV or sAFP was detected after chemotherapy cycle 2. Left lobe tumors had greater presenting levels of and significantly slower decay in sAFP compared with right lobe tumors (P = .005), although no statistically significant differences in TV existed between liver lobes. Resection margins did not change with therapy duration.
  
  
  CONCLUSIONS
  Measuring TV and sAFP kinetics accurately reflects hepatoblastoma responsiveness to induction therapy. Treatment toxicities may be reduced by earlier resection and tailoring of chemotherapeutic regimens.
authors.affiliation: Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN 37232-9780, USA. harold.lovvorn@vanderbilt.edu
authors.forename: Harold N
authors.initials: HN
authors.lastname: Lovvorn
authors.forename: Dan
authors.initials: D
authors.lastname: Ayers
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Zhao
authors.forename: Melissa
authors.initials: M
authors.lastname: Hilmes
authors.forename: Pinki
authors.initials: P
authors.lastname: Prasad
authors.forename: Myrick C
authors.initials: MC
authors.lastname: Shinall
authors.forename: Barry
authors.initials: B
authors.lastname: Berch
authors.forename: Wallace W
authors.initials: WW
authors.lastname: Neblett
authors.forename: James A
authors.initials: JA
authors.lastname: O'Neill
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D018197:Hepatoblastoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007223:Infant; D007700:Kinetics; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008297:Male; D020360:Neoadjuvant Therapy; D011300:Preoperative Care; D012074:Remission Induction / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000032:analysis / Q000378:metabolism*
chemical_list: D000509:alpha-Fetoproteins