title: Relapsed hepatoblastoma confined to the lung is effectively treated with pulmonary metastasectomy.
abstract: BACKGROUND
  In children diagnosed with hepatoblastoma (HB), the lungs are the most common site of metastasis at both initial presentation and relapse. Previous studies have encouraged pulmonary metastasectomy to achieve a disease-free state after resection of the primary hepatic lesion. However, there is no consensus about how to manage recurrent pulmonary metastasis.
  
  
  METHODS
  A retrospective, multi-institutional review was performed from 2005 to 2014 to identify HB patients ≤18years of age who had disease recurrence associated with pulmonary metastases alone.
  
  
  RESULTS
  Ten patients between the ages of 8 and 33months were identified. Pulmonary metastatic recurrence was detected by measuring alpha-fetoprotein (AFP) levels and/or with CT scans of the chest. All patients subsequently underwent pulmonary metastasectomy without post-operative complications. At last follow-up, 8 patients were alive and had normal AFP levels. The 8 survivors had a median follow-up from therapy completion of 18.5months. Two patients who presented with extrapulmonary recurrence subsequently died of treatment refractory disease.
  
  
  CONCLUSIONS
  This review supports surgical resection as a safe and, in the context of multimodal therapy, efficacious approach to manage HB patients who present with isolated pulmonary relapse.
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
authors.forename: Yan
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Division of Oncology, Cincinnati Children's Hospital Medical Center, Cancer and Blood Diseases Institute, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.
authors.forename: James I
authors.initials: JI
authors.lastname: Geller
authors.affiliation: Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
authors.forename: Irene T
authors.initials: IT
authors.lastname: Ma
authors.affiliation: Pediatric Hematology-Oncology, Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Rishikesh S
authors.initials: RS
authors.lastname: Chavan
authors.affiliation: Department of Pediatric Radiology, Texas Children's Hospital, Department of Radiology, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX.
authors.forename: Prakash M
authors.initials: PM
authors.lastname: Masand
authors.affiliation: Department of Radiology and Medical Imaging, Cincinnati Children's Hospital, Department of Radiology, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Towbin
authors.affiliation: Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
authors.forename: Murali
authors.initials: M
authors.lastname: Chintagumpala
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
authors.forename: Jed G
authors.initials: JG
authors.lastname: Nuchtern
authors.affiliation: Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Greg M
authors.initials: GM
authors.lastname: Tiao
authors.affiliation: Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina. Electronic address: patom@email.unc.edu.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Thompson
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas. Electronic address: sanjeevv@bcm.edu.
authors.forename: Sanjeev A
authors.initials: SA
authors.lastname: Vasudevan
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018197:Hepatoblastoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000473:pathology*; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy; D011013:Pneumonectomy; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hepatoblastoma; Lung metastasis; Metastasectomy; Pulmonary relapse; Recurrence; Surgical resection