title: Effect of neoadjuvant chemotherapy on resectability of stage III and IV hepatoblastoma.
abstract: BACKGROUND
  The potential for surgical resection of primary hepatoblastoma tumours was assessed at diagnosis, and after two and four cycles of neoadjuvant chemotherapy.
  
  
  METHODS
  Available radiographic images for patients with stage III and IV hepatoblastoma diagnosed between 1991 and 2008 were reviewed. The extent of disease was determined at diagnosis using the PRETEXT staging system, and after two and four cycles of therapy by POST-TEXT staging. Tumour resectability based on radiographic studies was assessed independently by two surgeons with expertise in hepatic surgery who were blinded to treatment and clinical outcome.
  
  
  RESULTS
  Radiographic images from 20 patients with hepatoblastoma were reviewed. Six of 20 tumours were downstaged after two cycles, and three additional tumours were downstaged following four cycles. All PRETEXT stage III and IV tumours were determined to be surgically unresectable at diagnosis. The number of tumours considered unresectable decreased from 16 of 20 at diagnosis to seven of 20 after two cycles, and to four of 20 after four cycles. Five of the seven tumours that were unresectable after two cycles, and all four tumours that were unresectable after four cycles would have qualified for liver transplant based on radiographic studies.
  
  
  CONCLUSIONS
  The majority of stage III and IV hepatoblastomas achieved radiographic resectability after two cycles of chemotherapy. There may be an opportunity for earlier surgical intervention and potential for a reduction in chemotherapy in a considerable number of patients.
authors.affiliation: Divisions of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, California, USA; Departments of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: R
authors.initials: R
authors.lastname: Venkatramani
authors.forename: J E
authors.initials: JE
authors.lastname: Stein
authors.forename: A
authors.initials: A
authors.lastname: Sapra
authors.forename: Y
authors.initials: Y
authors.lastname: Genyk
authors.forename: V
authors.initials: V
authors.lastname: Jhaveri
authors.forename: M
authors.initials: M
authors.lastname: Malogolowkin
authors.forename: L
authors.initials: L
authors.lastname: Mascarenhas
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins; D018197:Hepatoblastoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D014682:Vena Cava, Inferior