title: PRETEXT II-III multifocal hepatoblastoma: significance of resection of satellite lesions irrespective of their disappearance after chemotherapy.
abstract: OBJECTIVE
  To determine the outcomes of resection of satellite lesions in PRE-treatment Tumor EXTension (PRETEXT) II and III multifocal hepatoblastoma irrespective of their disappearance after chemotherapy. To compare the overall outcomes of multifocal and unifocal hepatoblastoma.
  
  
  METHODS
  Fourteen patients with PRETEXT II (n = 7) and III (n = 7) multifocal hepatoblastoma treated between April 2006 and July 2014 were analyzed and their outcomes were compared with PRETEXT II and III unifocal hepatoblastoma treated in the similar period.
  
  
  RESULTS
  Satellite lesion or the affected segments with disappeared satellite lesions were resected in 11 patients. Amongst them, all relapses were distant except one in the liver. In contrast, two of three patients developed liver relapse when the affected segments were not resected. None of the patients receiving intensive chemotherapy based on SIOPEL-3 guidelines developed a relapse. The 3-year event-free and overall survival were 38.6 and 42.9% in multifocal hepatoblastoma and 86.4 and 92.4% in unifocal hepatoblastoma (p = 0.001). Multifocality (p = 0.002) and AFP >10,000 after induction chemotherapy significantly affected event-free survival (p = 0.01).
  
  
  CONCLUSIONS
  Multifocal hepatoblastoma is associated with poor outcomes as compared to unifocal hepatoblastoma. These preliminary observations of relapse and the role of chemotherapy intensification deserve further study in a multicenter controlled trial setting.
authors.affiliation: Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Ernest Borges Road, Parel, 400012, Bombay, India, sajidshafiques@hotmail.com.
authors.forename: Sajid S
authors.initials: SS
authors.lastname: Qureshi
authors.forename: Monica
authors.initials: M
authors.lastname: Bhagat
authors.forename: Seema
authors.initials: S
authors.lastname: Kembhavi
authors.forename: Tushar
authors.initials: T
authors.lastname: Vora
authors.forename: Mukta
authors.initials: M
authors.lastname: Ramadwar
authors.forename: Sanjay
authors.initials: S
authors.lastname: Talole
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D018197:Hepatoblastoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008099:Liver / Q000000981:diagnostic imaging / Q000601:surgery; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome