title: Multidisciplinary management of hepatoblastoma in children: Experience from a developing country.
abstract: Advances in chemotherapy, liver resection techniques, and pediatric liver transplantation have vastly improved survival in children with hepatoblastoma (HB). These are best managed by a multidisciplinary team (MDT) in a setting where all treatment options are available. Until recently, this was difficult to achieve in India.
  
  
  
  All children (<16 years) with HB treated in a pediatric liver surgery and transplantation unit between January 2011 and July 2016 were reviewed. Data regarding the clinical presentation, preoperative management, surgical treatment, postoperative course, and outcomes were extracted from a prospectively managed database.
  
  
  
  Thirty children were treated for HB during the study period. Nine children were PRETEXT 4, 7 were PRETEXT 3, 13 were PRETEXT 2, and 1 was PRETEXT 1 (where PRETEXT is pretreatment extension). All children received a neoadjuvant chemotherapy before surgery followed by an adjuvant chemotherapy. Nineteen children had complete resection, while six underwent primary living donor liver transplantation. There were six mortalities including five children who poorly responded to chemotherapy with progressive tumor extension. At a median follow-up of 30 months, two children who underwent resection and one child who underwent liver transplant had disease recurrence.
  
  
  
  Improved outcomes can be achieved in children with HB even in countries with limited resources when they are managed by MDTs with expertise in pediatric oncology, liver resection, and liver transplantation.
authors: Department of Pediatric Gastroenterology, Hepatology and Nutrition, Global Health City, Chennai, Tamil Nadu, India.
authors: Naresh
authors: N
authors: Shanmugam
authors: Department of Pediatric Hematology and Oncology, Global Health City, Chennai, Tamil Nadu, India.
authors: Julius Xavier
authors: JX
authors: Scott
authors: Department of Pediatric Hematology and Oncology, Global Health City, Chennai, Tamil Nadu, India.
authors: Vimal
authors: V
authors: Kumar
authors: Department of Histopathology, Global Health City, Chennai, Tamil Nadu, India.
authors: Mukul
authors: M
authors: Vij
authors: Institute of Liver Diseases & Transplantation, Global Health City, Chennai, Tamil Nadu, India.
authors: Priya
authors: P
authors: Ramachandran
authors: Institute of Liver Diseases & Transplantation, Global Health City, Chennai, Tamil Nadu, India.
authors: Gomathy
authors: G
authors: Narasimhan
authors: Institute of Liver Diseases & Transplantation, Global Health City, Chennai, Tamil Nadu, India.
authors: Mettu Srinivas
authors: MS
authors: Reddy
authors: Institute of Liver Diseases & Transplantation, Global Health City, Chennai, Tamil Nadu, India.
authors: Venugopal
authors: V
authors: Kota
authors: Department of Histopathology, Global Health City, Chennai, Tamil Nadu, India.
authors: Deenadayalan
authors: D
authors: Munirathnam
authors: Department of Pediatric Gastroenterology, Hepatology and Nutrition, Global Health City, Chennai, Tamil Nadu, India.
authors: Chayarani
authors: C
authors: Kelgeri
authors: Department of Pediatric Gastroenterology, Hepatology and Nutrition, Global Health City, Chennai, Tamil Nadu, India.
authors: Karthick
authors: K
authors: Sundaram
authors: Department of Pediatric Gastroenterology, Hepatology and Nutrition, Global Health City, Chennai, Tamil Nadu, India.
authors: Mohamed
authors: M
authors: Rela
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D018197:Hepatoblastoma / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007194:India; D007223:Infant; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate
keywords: SIOPEL; chemotherapy; hepatoblastoma; liver transplantation; multidisciplinary