Imaging analysis of hepatoblastoma resectability across neoadjuvant chemotherapy.

Murphy AJ, Ayers GD, Hilmes MA, Mukherjee K, Wilson KJ, Allen WM, Fernandez-Pineda I, Shinall MC, Zhao Z, Furman WL, McCarville MB, Davidoff AM, Lovvorn HN
J Pediatr Surg. 2013 48 (6): 1239-48

PMID: 23845613 · PMCID: PMC3735614 · DOI:10.1016/j.jpedsurg.2013.03.019

PURPOSE - Hepatoblastomas often require neoadjuvant chemotherapy to facilitate partial hepatectomy, which necessitates freedom of tumor borders from the confluence of hepatic veins (COHV), portal vein bifurcation (PVB), and retrohepatic inferior vena cava (IVC). This study aimed to clarify the effect of incremental neoadjuvant cycles on the AHEP0731 protocol criteria of hepatoblastoma resectability.

METHODS - Hepatoblastoma responses to neoadjuvant chemotherapy were analyzed among patients (n=23) treated at two children's hospitals between 1996 and 2010. Using digital imaging data, ellipsoid and point-based models were created to measure tumor volume regression and respective distances from tumor borders nearest to the COHV, PVB, and IVC.

RESULTS - Hepatoblastoma volumes regressed with incremental neoadjuvant chemotherapy cycles (p<0.001). Although tumor borders regressed away from the COHV (p=0.008), on average only 1.1mm was gained. No change from tumor borders to the PVB was detected (p=0.102). Distances from tumor borders to the IVC remained stable at one hospital (p=0.612), but increased only 0.15 mm every 10 days of therapy at the other (p=0.002). Neoadjuvant chemotherapy induced slightly more tumors to meet the threshold vascular margin of 1cm (baseline to completion): COHV, 11 (47.8%) to 17 (73.9%; p=0.058); PVB, 11 (47.8%) to 15 (65.2%; p=0.157); and IVC, 4 (17.4%) to 10 (43.5%; p=0.034). No differences were detected in demographic or disease-specific characteristics between patients who did or did not achieve this 1-cm margin after conclusion of chemotherapy.

CONCLUSION - Hepatoblastoma volumes regress significantly with increasing neoadjuvant chemotherapy cycles. However, tumors often remain anchored to the major hepatic vasculature, showing marginal improvement in resectability criteria.

Copyright © 2013 Elsevier Inc. All rights reserved.

MeSH Terms (23)

Algorithms Antineoplastic Agents Antineoplastic Combined Chemotherapy Protocols Chemotherapy, Adjuvant Cisplatin Clinical Protocols Doxorubicin Female Fluorouracil Hepatectomy Hepatoblastoma Humans Image Interpretation, Computer-Assisted Liver Neoplasms Magnetic Resonance Imaging Male Models, Statistical Neoadjuvant Therapy Retrospective Studies Tomography, X-Ray Computed Treatment Outcome Tumor Burden Vincristine

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