title: Imaging analysis of hepatoblastoma resectability across neoadjuvant chemotherapy.
abstract: OBJECTIVE
  Hepatoblastomas often require neoadjuvant chemotherapy to facilitate partial hepatectomy, which necessitates freedom of tumor borders from the confluence of hepatic veins (COHV), portal vein bifurcation (PVB), and retrohepatic inferior vena cava (IVC). This study aimed to clarify the effect of incremental neoadjuvant cycles on the AHEP0731 protocol criteria of hepatoblastoma resectability.
  
  
  METHODS
  Hepatoblastoma responses to neoadjuvant chemotherapy were analyzed among patients (n=23) treated at two children's hospitals between 1996 and 2010. Using digital imaging data, ellipsoid and point-based models were created to measure tumor volume regression and respective distances from tumor borders nearest to the COHV, PVB, and IVC.
  
  
  RESULTS
  Hepatoblastoma volumes regressed with incremental neoadjuvant chemotherapy cycles (p<0.001). Although tumor borders regressed away from the COHV (p=0.008), on average only 1.1mm was gained. No change from tumor borders to the PVB was detected (p=0.102). Distances from tumor borders to the IVC remained stable at one hospital (p=0.612), but increased only 0.15 mm every 10 days of therapy at the other (p=0.002). Neoadjuvant chemotherapy induced slightly more tumors to meet the threshold vascular margin of 1cm (baseline to completion): COHV, 11 (47.8%) to 17 (73.9%; p=0.058); PVB, 11 (47.8%) to 15 (65.2%; p=0.157); and IVC, 4 (17.4%) to 10 (43.5%; p=0.034). No differences were detected in demographic or disease-specific characteristics between patients who did or did not achieve this 1-cm margin after conclusion of chemotherapy.
  
  
  CONCLUSIONS
  Hepatoblastoma volumes regress significantly with increasing neoadjuvant chemotherapy cycles. However, tumors often remain anchored to the major hepatic vasculature, showing marginal improvement in resectability criteria.
authors.affiliation: Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-2730, USA. andrew.j.murphy@vanderbilt.edu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Murphy
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Ayers
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Hilmes
authors.forename: Kaushik
authors.initials: K
authors.lastname: Mukherjee
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Wilson
authors.forename: Wade M
authors.initials: WM
authors.lastname: Allen
authors.forename: Israel
authors.initials: I
authors.lastname: Fernandez-Pineda
authors.forename: Myrick C
authors.initials: MC
authors.lastname: Shinall
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Zhao
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Furman
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: McCarville
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Davidoff
authors.forename: Harold N
authors.initials: HN
authors.lastname: Lovvorn
mesh_terms: D000465:Algorithms; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D002985:Clinical Protocols; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006498:Hepatectomy; D018197:Hepatoblastoma / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008113:Liver Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D015233:Models, Statistical; D020360:Neoadjuvant Therapy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000970:Antineoplastic Agents; D014750:Vincristine; D004317:Doxorubicin; D002945:Cisplatin; D005472:Fluorouracil
keywords: AHEP0731; Hepatoblastoma; Neoadjuvant chemotherapy; Tumor regression; Tumor volume