title: Hepatoblastoma state of the art: pre-treatment extent of disease, surgical resection guidelines and the role of liver transplantation.
abstract: OBJECTIVE
  This is part two of a two-part state of the art--hepatoblastoma. International hepatoblastoma specialists were brought together to highlight advances, controversies, and future challenges in the treatment of this rare pediatric tumor.
  
  
  RESULTS
  Pretreatment extent of disease (PRETEXT) is a grouping system introduced as part of the multicenter international childhood liver tumors strategy group, SIOPEL-1, study in 1990. The system has been refined over the ensuing years and has now come to be adopted for risk stratification by all of the major pediatric liver tumor multicenter trial groups. PRETEXT is being intensively studied in the current Children's Oncology Group (COG) AHEP-0731 trial in an attempt to validate interobserver reproducibility and ability to monitor response to neoadjuvant chemotherapy, and determine surgical resectability. PRETEXT is now used to identify those patients who are at risk for having an unresectable tumor and who should be referred to a liver specialty center with transplant capability early in their treatment schema.
  
  
  CONCLUSIONS
  International collaborative efforts in hepatoblastoma have led to increased refinements in the use of the PRETEXT and post-treatment extent to define prognosis and surgical resectability. PRETEXT criteria which suggest a possible need for liver transplantation are discussed in detail.
authors.affiliation: aPediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah bPediatric Surgery, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA cDepartment of Pediatric Surgery and Transplantation, Ospedale Pediatrico Bambino Gesù, University of Rome 'Tor Vergata', Italy dPediatric Surgery, Lurie Children's Hospital of Chicago, Chicago, Illinois, USA eQueen Elisabeth Central Hospital, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: Rebecka L
authors.initials: RL
authors.lastname: Meyers
authors.forename: Greg
authors.initials: G
authors.lastname: Tiao
authors.forename: Jean
authors.initials: J
authors.lastname: de Ville de Goyet
authors.forename: Riccardo
authors.initials: R
authors.lastname: Superina
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Aronson
mesh_terms: D002648:Child; D018197:Hepatoblastoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D017410:Practice Guidelines as Topic; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index