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Pediatric Hepatoblastoma Follow-up

  • Author: Jennifer Reikes Willert, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
 
Updated: Nov 17, 2014
 

Further Outpatient Care

See the list below:

  • Patients are periodically monitored in the clinic after each course of therapy to assess for complications and response to therapy.
  • Myelosuppression and pancytopenia are common complications, and a CBC count with a platelet count is obtained once or twice weekly.
  • Some drugs, such as cisplatin and carboplatin, affect renal function and require close monitoring of electrolytes and oral or parenteral electrolyte supplementation.
  • Blood product support is provided when the hemoglobin drops below 8 g/dL, symptoms of anemia are present, the platelet count drops below 10,000 X 10 9/L, or any signs of bleeding are evident.
  • Fever must be treated as a medical emergency during therapy because the risk of a bacterial or fungal infection is high in patients with myelosuppression.
  • Children with central lines are susceptible to bacteremia and life-threatening sepsis. In addition, all children with central lines must receive appropriate antimicrobial prophylaxis against subacute bacterial endocarditis (SBE) for all procedures, including dental procedures.
  • Close contact with the liver transplant team is required for patients who require this treatment. All medical decisions for patients with this complex condition should be communicated to all members of the team including oncologists, primary surgeon, hepatologists, and transplant surgeons.
  • Late effects clinics are available at most major oncology centers, and children with hepatoblastoma should be referred to these clinics if they remain disease free for more than 2 years. Even if the risk of recurrence decreases with time, these children are still at risk for late effects, which include secondary cancers (etoposide and anthracycline), cardiotoxicity (anthracycline), renal toxicity (platinum agents), ototoxicity (platinum agents), and potential speech and developmental delays due to therapy administered.
  • Psychosocial team members, child life experts, medical social workers, nutritionists, and all care providers can help families adjust to life after cancer and can also help encourage a cancer preventive lifestyle for these at-risk patients.
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Further Inpatient Care

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  • Follow-up care: Children may be admitted to the hospital to expedite the diagnostic workup or when severe signs or symptoms are present. For medically stable patients, the workup can be performed in the outpatient setting. A central line is typically placed when the patient is scheduled for biopsy or resection. Double-lumen central lines are preferred if vessel access is adequate because this allows concurrent administration of multiple parenteral medications.
  • Multidisciplinary evaluation: The child is initially evaluated by a pediatric oncologist and surgeons with expertise in childhood malignancies. Evaluation should be performed at a pediatric cancer center. Once the diagnosis is established and the staging workup is completed, the patient and family are instructed on the diagnosis and therapeutic options. Most children and families are offered participation in cooperative group trials. Once the treatment plan is developed, chemotherapy is most frequently administered in the inpatient setting. However, with improvements in supportive care, some chemotherapy may be administered in the outpatient setting. Following completion of the treatment cycle, patients are discharged home with detailed instructions for home care and outpatient follow-up visits.
  • Liver transplantation: Patients who undergo liver transplantation require a multidisciplinary team with experienced hepatologist and liver transplant surgeons as well as the team outlined above.
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Inpatient & Outpatient Medications

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  • Infection prophylaxis: Chemotherapy agents cause myelosuppression and immunosuppression. Prophylaxis against Pneumocystis jiroveci, which causes Pneumocystis carinii pneumonia, is recommended for all patients. The drug of choice is trimethoprim-sulfamethoxazole (2.5 mg/kg/dose of trimethoprim administered orally twice daily) administered on 3 consecutive days per week. Prophylaxis is initiated before chemotherapy and is continued for at least 3 months after completing therapy.
  • Colony-stimulating factors: Granulocyte colony-stimulating factor (G-CSF) support has become common in pediatric oncology as the intensity of chemotherapy has increased. The doses recommended are 5-10 mcg/kg/d, starting 24-36 hours after the last dose of chemotherapy. G-CSF administration is continued for 10-14 days or until the absolute neutrophil count (ANC) is greater than 2,000-10,000/mcL.
  • Erythropoietin: The use of erythropoietin is discouraged because of reports that hepatoblastoma has receptors for this agent and may therefore be stimulated to grow from exogenous sources.
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Transfer

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  • With supervision by the oncology team, routine care can be performed by the primary care provider for patient convenience. CBC counts and blood chemistries may be obtained and blood products may be administered by primary care providers.
  • Some patients may even be evaluated and treated for febrile neutropenia by the primary care provider. However, the primary care provider must maintain close contact with the subspecialist physicians and transfer the patient to the pediatric oncology center for any complications that require specialized care.
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Deterrence/Prevention

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  • The cause of hepatoblastoma is unknown. Because onset of hepatoblastoma is in patients at a young age, investigators have focused on events before conception and during gestation. Factors for which evidence is limited or inconsistent include medications, hormones, birth characteristics, congenital anomalies, previous spontaneous abortion or fetal death, alcohol consumption, tobacco use, and paternal occupational exposures.
  • Children with hemihypertrophy or Beckwith-Wiedemann syndrome (BWS) and children born to individuals affected by familial adenomatous polyposis (FAP) should be screened regularly using blood α -fetoprotein (AFP) levels as dictated in current protocols. Children found to harbor a FAP mutation should be periodically monitored for the development of polyps by a gastroenterologist as they reach the teenage years.
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Complications

Tumor rupture may occur at diagnosis, resulting in acute abdomen or severe hemorrhage, both of which constitute medical emergencies. Intraoperative and postoperative complications may occur as a result of resection or biopsy procedures.

Complications can develop with the administration of chemotherapy. Myelosuppression and immunosuppression place the patient at risk for bleeding and infection. After several cycles of therapy, organ toxicity may occur; for example, renal function or hearing may be impaired.

Posttransplantion complications can develop and require close long-term follow-up by the liver transplant team.

Particular attention must be paid to cardiac, renal, and hearing status to assess for the long-term toxic effects of anthracyclines, cisplatin, or carboplatin. One of the most important adverse effects of platinum chemotherapy is hearing loss. A Cochrane Database review of 3 studies that evaluated the use of the chemoprotective agent amifostine versus no additional treatment did not come to any definitive conclusions. Further research is needed regarding the usefulness of possible drugs to prevent hearing loss in children treated with platinum chemotherapy.[45]

Psychosocial effects of frequent painful procedures, hospitalizations, and interference with normal childhood growth and development must be addressed, and children and families must be referred to appropriate specialists when needed. The family's psychosocial needs are affected greatly by having a child with cancer.

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Patient Education

See the list below:

  • Medications: To ensure compliance and good medical care, patient and family understanding regarding the importance of treatment and the toxic effects of the medications is critical. In addition, patients and their families should learn to recognize and identify signs and symptoms of complications that require urgent medical care.
  • Long-term follow-up surveillance: After completion of therapy, patients in whom treatment was successful require close surveillance for any signs or symptoms of recurrent disease. Follow-up care includes monitoring AFP levels, physical examination, and diagnostic imaging. Because most recurrences occur during the first 2 years following treatment, most protocols recommend close follow-up monitoring during this interval. Hepatoblastoma does not usually recur more than 3 years after completion of therapy.
  • Long-term issues: Growth and development and long-term toxic effects on organs are long-term issues. Patients who remain free of recurrent disease for 5 years are considered cured; long-term follow-up monitoring to assess the impact of therapy on growth, development, and organ toxicity is essential. Patients are usually monitored by pediatric oncologists, but some sequelae may require the involvement of other subspecialist health care providers.
  • Other issues: Most centers have late effects clinics, and all children treated for cancer should continue to see their oncology providers regularly to monitor for potential long-term complications of therapy. When appropriate, most centers help transition to an adult provider, with guidelines on what to watch for and which tests should be performed to monitor for potential late effects. A cancer-preventive lifestyle is encouraged and includes avoiding passive or primary tobacco exposure, wearing sunscreen, healthy eating habits, maintaining a healthy weight, and an exercise regimen.
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Contributor Information and Disclosures
Author

Jennifer Reikes Willert, MD Associate Clinical Professor, Department of Pediatrics, Division of Pediatric Hematology/Oncology, Section of Stem Cell Transplantation, Stanford University Medical Center, Lucile Packard Children's Hospital

Jennifer Reikes Willert, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Hematology, American Society for Blood and Marrow Transplantation, Children's Oncology Group, American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Coauthor(s)

Gary Dahl, MD Professor, Department of Pediatrics, Division of Hematology/Oncology, Stanford University School of Medicine

Gary Dahl, MD is a member of the following medical societies: American Society of Hematology, American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Alexandra (Lowry) Abrams, MD Associate Medical Director, George Mark Children’s House

Disclosure: Nothing to disclose.

Arun A Rangaswami, MD Clinical Associate Professor of Pediatrics, Associate Director, Pediatric Hematology-Oncology Fellowship Program, Stanford University School of Medicine

Arun A Rangaswami, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, Children's Oncology Group

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Steven K Bergstrom, MD Department of Pediatrics, Division of Hematology-Oncology, Kaiser Permanente Medical Center of Oakland

Steven K Bergstrom, MD is a member of the following medical societies: Alpha Omega Alpha, Children's Oncology Group, American Society of Clinical Oncology, International Society for Experimental Hematology, American Society of Hematology, American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Chief Editor

Max J Coppes, MD, PhD, MBA Executive Vice President, Chief Medical and Academic Officer, Renown Heath

Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American College of Healthcare Executives, American Society of Pediatric Hematology/Oncology, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Stephan A Grupp, MD, PhD Director, Stem Cell Biology Program, Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia; Associate Professor of Pediatrics, University of Pennsylvania School of Medicine

Stephan A Grupp, MD, PhD is a member of the following medical societies: American Association for Cancer Research, Society for Pediatric Research, American Society for Blood and Marrow Transplantation, American Society of Hematology, American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Acknowledgements

The authors would like to thank all of our patients and families, as well as all of our mentors along this path towards a better outcome for children with hepatoblastoma!

References
  1. Castellino AM. Children with hepatoblastoma: could less chemo be used?. Medscape Medical News. November 5, 2014. [Full Text].

  2. Venkatramani R, Stein JE, Sapra A, Genyk Y, Jhaveri V, Malogolowkin M, et al. Effect of neoadjuvant chemotherapy on resectability of stage III and IV hepatoblastoma. Br J Surg. 2014 Oct 28. [Medline].

  3. Ang JP, Heath JA, Donath S, Khurana S, Auldist A. Treatment outcomes for hepatoblastoma: an institution's experience over two decades. Pediatr Surg Int. 2007 Feb. 23(2):103-9. [Medline].

  4. Otte JB, Pritchard J, Aronson DC, et al. Liver transplantation for hepatoblastoma: results from the International Society of Pediatric Oncology (SIOP) study SIOPEL-1 and review of the world experience. Pediatr Blood Cancer. 2004 Jan. 42(1):74-83. [Medline].

  5. Otte JB, de Ville de Goyet J, Reding R. Liver transplantation for hepatoblastoma: indications and contraindications in the modern era. Pediatr Transplant. 2005 Oct. 9(5):557-65. [Medline].

  6. Czauderna P, Mackinlay G, Perilongo G, et al. Hepatocellular carcinoma in children: results of the first prospective study of the International Society of Pediatric Oncology group. J Clin Oncol. 2002 Jun 15. 20(12):2798-804. [Medline].

  7. Hirschman BA, Pollock BH, Tomlinson GE. The spectrum of APC mutations in children with hepatoblastoma from familial adenomatous polyposis kindreds. J Pediatr. 2005 Aug. 147(2):263-6. [Medline].

  8. Sanders RP, Furman WL. Familial adenomatous polyposis in two brothers with hepatoblastoma: implications for diagnosis and screening. Pediatr Blood Cancer. 2006 Nov. 47(6):851-4. [Medline].

  9. Harvey J, Clark S, Hyer W, Hadzic N, Tomlinson I, Hinds R. Germline APC mutations are not commonly seen in children with sporadic hepatoblastoma. J Pediatr Gastroenterol Nutr. 2008 Nov. 47(5):675-7. [Medline].

  10. Anna CH, Sills RC, Foley JF, Stockton PS, Ton TV, Devereux TR. Beta-catenin mutations and protein accumulation in all hepatoblastomas examined from B6C3F1 mice treated with anthraquinone or oxazepam. Cancer Res. 2000 Jun 1. 60(11):2864-8. [Medline].

  11. Koch A, Waha A, Hartmann W, et al. Elevated expression of Wnt antagonists is a common event in hepatoblastomas. Clin Cancer Res. 2005 Jun 15. 11(12):4295-304. [Medline].

  12. Tan X, Apte U, Micsenyi A, et al. Epidermal growth factor receptor: a novel target of the Wnt/beta-catenin pathway in liver. Gastroenterology. 2005 Jul. 129(1):285-302. [Medline].

  13. Wirths O, Waha A, Weggen S, et al. Overexpression of human Dickkopf-1, an antagonist of wingless/WNT signaling, in human hepatoblastomas and Wilms' tumors. Lab Invest. 2003 Mar. 83(3):429-34. [Medline].

  14. Miao J, Kusafuka T, Udatsu Y, Okada A. Sequence variants of the Axin gene in hepatoblastoma. Hepatol Res. 2003 Feb. 25(2):174-179. [Medline].

  15. Taniguchi K, Roberts LR, Aderca IN, et al. Mutational spectrum of beta-catenin, AXIN1, and AXIN2 in hepatocellular carcinomas and hepatoblastomas. Oncogene. 2002 Jul 18. 21(31):4863-71. [Medline].

  16. Kuroda T, Rabkin SD, Martuza RL. Effective treatment of tumors with strong beta-catenin/T-cell factor activity by transcriptionally targeted oncolytic herpes simplex virus vector. Cancer Res. 2006 Oct 15. 66(20):10127-35. [Medline].

  17. Arsic D, Beasley SW, Sullivan MJ. Switched-on Sonic hedgehog: a gene whose activity extends beyond fetal development - to oncogenesis. J Paediatr Child Health. 2007 Jun. 43(6):421-3. [Medline].

  18. Eichenmuller M, Gruner I, Hagl B, et al. Blocking the hedgehog pathway inhibits hepatoblastoma growth. Hepatology. 2009 Feb. 49(2):482-90. [Medline].

  19. Lopez-Terrada D, Gunaratne PH, Adesina AM, et al. Histologic subtypes of hepatoblastoma are characterized by differential canonical Wnt and Notch pathway activation in DLK+ precursors. Hum Pathol. 2009 Jun. 40(6):783-94. [Medline].

  20. Ruck P, Xiao JC. Stem-like cells in hepatoblastoma. Med Pediatr Oncol. 2002 Nov. 39(5):504-7. [Medline].

  21. Tanimura M, Matsui I, Abe J, et al. Increased risk of hepatoblastoma among immature children with a lower birth weight. Cancer Res. 1998 Jul 15. 58(14):3032-5. [Medline].

  22. Ortega JA, Douglass EC, Feusner JH, et al. Randomized comparison of cisplatin/vincristine/fluorouracil and cisplatin/continuous infusion doxorubicin for treatment of pediatric hepatoblastoma: A report from the Children's Cancer Group and the Pediatric Oncology Group. J Clin Oncol. 2000 Jul. 18(14):2665-75. [Medline].

  23. Aronson DC, Schnater JM, Staalman CR, et al. Predictive value of the pretreatment extent of disease system in hepatoblastoma: results from the International Society of Pediatric Oncology Liver Tumor Study Group SIOPEL-1 study. J Clin Oncol. 2005 Feb 20. 23(6):1245-52. [Medline].

  24. Feusner J, Plaschkes J. Hepatoblastoma and low birth weight: a trend or chance observation?. Med Pediatr Oncol. 2002 Nov. 39(5):508-9. [Medline].

  25. Oue T, Kubota A, Okuyama H, et al. Hepatoblastoma in children of extremely low birth weight: a report from a single perinatal center. J Pediatr Surg. 2003 Jan. 38(1):134-7; discussion 134-7. [Medline].

  26. Ucar C, Caliskan U, Toy H. Hepatoblastoma in a child with neurofibromatosis type I. Pediatr Blood Cancer. 2005 Nov 10. [Medline].

  27. Toxicology and Carcinogenesis Studies of Bromochloroacetic Acid (CAS No. 5589-96-8) in F344/N Rats and B6C3F1 Mice (Drinking Water Studies). Natl Toxicol Program Tech Rep Ser. 2009 Feb. 1-270. [Medline].

  28. Fuchs J, Rydzynski J, Von Schweinitz D, et al. Pretreatment prognostic factors and treatment results in children with hepatoblastoma: a report from the German Cooperative Pediatric Liver Tumor Study HB 94. Cancer. 2002 Jul 1. 95(1):172-82. [Medline].

  29. Figarola MS, McQuiston SA, Wilson F, Powell R. Recurrent hepatoblastoma with localization by PET-CT. Pediatr Radiol. 2005 Dec. 35(12):1254-8. [Medline].

  30. Rowland JM. Hepatoblastoma: assessment of criteria for histologic classification. Med Pediatr Oncol. 2002 Nov. 39(5):478-83. [Medline].

  31. von Schweinitz D, Hecker H, Schmidt-von-Arndt G, Harms D. Prognostic factors and staging systems in childhood hepatoblastoma. Int J Cancer. 1997 Dec 19. 74(6):593-9. [Medline].

  32. Douglass EC, Reynolds M, Finegold M, Cantor AB, Glicksman A. Cisplatin, vincristine, and fluorouracil therapy for hepatoblastoma: a Pediatric Oncology Group study. J Clin Oncol. 1993 Jan. 11(1):96-9. [Medline].

  33. Casanova M, Massimino M, Ferrari A, et al. Etoposide, cisplatin, epirubicin chemotherapy in the treatment of pediatric liver tumors. Pediatr Hematol Oncol. 2005 Apr-May. 22(3):189-98. [Medline].

  34. Perilongo G, Maibach R, Shafford E, et al. Cisplatin versus cisplatin plus doxorubicin for standard-risk hepatoblastoma. N Engl J Med. 2009 Oct 22. 361(17):1662-70. [Medline].

  35. McCrudden KW, Hopkins B, Frischer J, et al. Anti-VEGF antibody in experimental hepatoblastoma: suppression of tumor growth and altered angiogenesis. J Pediatr Surg. 2003 Mar. 38(3):308-14; discussion 308-14. [Medline].

  36. Warmann S, Gohring G, Teichmann B, Geerlings H, Fuchs J. MDR1 modulators improve the chemotherapy response of human hepatoblastoma to doxorubicin in vitro. J Pediatr Surg. 2002 Nov. 37(11):1579-84. [Medline].

  37. Warmann S, Hunger M, Teichmann B, Flemming P, Gratz KF, Fuchs J. The role of the MDR1 gene in the development of multidrug resistance in human hepatoblastoma: clinical course and in vivo model. Cancer. 2002 Oct 15. 95(8):1795-801. [Medline].

  38. Rana AN, Qidwai A, Pritchard J, Ashraf MS. Successful treatment of multifocal unresectable hepatoblastoma with chemotherapy only. Pediatr Hematol Oncol. 2006 Mar. 23(2):153-8. [Medline].

  39. Widemann BC, Goodspeed W, Goodwin A, Fojo T, Balis FM, Fox E. Phase I trial and pharmacokinetic study of ixabepilone administered daily for 5 days in children and adolescents with refractory solid tumors. J Clin Oncol. 2009 Feb 1. 27(4):550-6. [Medline].

  40. Levy CF, Oo KZ, Fireman F, et al. Reversible posterior leukoencephalopathy syndrome in a child treated with bevacizumab. Pediatr Blood Cancer. 2009 May. 52(5):669-71. [Medline].

  41. Katzenstein HM, London WB, Douglass EC, et al. Treatment of unresectable and metastatic hepatoblastoma: a pediatric oncology group phase II study. J Clin Oncol. 2002 Aug 15. 20(16):3438-44. [Medline].

  42. Katzenstein HM, Rigsby C, Shaw PH, Mitchell TL, Haut PR, Kletzel M. Novel therapeutic approaches in the treatment of children with hepatoblastoma. J Pediatr Hematol Oncol. 2002 Dec. 24(9):751-5. [Medline].

  43. Fuchs J, Rydzynski J, Hecker H, et al. The influence of preoperative chemotherapy and surgical technique in the treatment of hepatoblastoma--a report from the German Cooperative Liver Tumour Studies HB 89 and HB 94. Eur J Pediatr Surg. 2002 Aug. 12(4):255-61. [Medline].

  44. Finegold MJ. Chemotherapy for suspected hepatoblastoma without efforts at surgical resection is a bad practice. Med Pediatr Oncol. 2002 Nov. 39(5):484-6. [Medline].

  45. van As JW, van den Berg H, van Dalen EC. Medical interventions for the prevention of platinum-induced hearing loss in children with cancer. Cochrane Database Syst Rev. 2012 May 16. 5:CD009219. [Medline].

  46. Adesina AM, Lopez-Terrada D, Wong KK, et al. Gene expression profiling reveals signatures characterizing histologic subtypes of hepatoblastoma and global deregulation in cell growth and survival pathways. Hum Pathol. 2009 Jun. 40(6):843-53. [Medline].

  47. Aihara R, Ohno T, Mochiki E, et al. Gastrointestinal stromal tumor of the lesser omentum in a young adult patient with a history of hepatoblastoma: Report of a case. Surg Today. 2009. 39(4):349-52. [Medline].

  48. Beaunoyer M, Vanatta JM, Ogihara M, et al. Outcomes of transplantation in children with primary hepatic malignancy. Pediatr Transplant. 2007 Sep. 11(6):655-60. [Medline].

  49. Blaker H, Hofmann WJ, Rieker RJ, et al. Beta-catenin accumulation and mutation of the CTNNB1 gene in hepatoblastoma. Genes Chromosomes Cancer. 1999 Aug. 25(4):399-402. [Medline].

  50. Borger JA, Barbosa JL, Lehan CA. Chemotherapy combined with surgery in successful treatment of hepatoblastoma. J Fla Med Assoc. 1989 Dec. 76(12):1023-6. [Medline].

  51. Cairo S, Armengol C, De Reynies A, et al. Hepatic stem-like phenotype and interplay of Wnt/beta-catenin and Myc signaling in aggressive childhood liver cancer. Cancer Cell. 2008 Dec 9. 14(6):471-84. [Medline].

  52. Cohen MM Jr. Beckwith-Wiedemann syndrome: historical, clinicopathological, and etiopathogenetic perspectives. Pediatr Dev Pathol. 2005 May-Jun. 8(3):287-304. [Medline].

  53. Conran RM, Hitchcock CL, Waclawiw MA, Stocker JT, Ishak KG. Hepatoblastoma: the prognostic significance of histologic type. Pediatr Pathol. 1992 Mar-Apr. 12(2):167-83. [Medline].

  54. [Guideline] Czauderna P, Otte JB, Aronson DC, et al. Guidelines for surgical treatment of hepatoblastoma in the modern era--recommendations from the Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL). Eur J Cancer. 2005 May. 41(7):1031-6. [Medline].

  55. Czauderna P, Zbrzezniak G, Narozanski W, Korzon M, Wyszomirska M, Stoba C. Preliminary experience with arterial chemoembolization for hepatoblastoma and hepatocellular carcinoma in children. Pediatr Blood Cancer. 2006 Jun. 46(7):825-8. [Medline].

  56. D'Antiga L, Vallortigara F, Cillo U, et al. Features predicting unresectability in hepatoblastoma. Cancer. 2007 Sep 1. 110(5):1050-8. [Medline].

  57. Ehrlich PF, Greenberg ML, Filler RM. Improved long-term survival with preoperative chemotherapy for hepatoblastoma. J Pediatr Surg. 1997 Jul. 32(7):999-1002; discussion 1002-3. [Medline].

  58. Faraj W, Dar F, Marangoni G, et al. Liver transplantation for hepatoblastoma. Liver Transpl. 2008 Nov. 14(11):1614-9. [Medline].

  59. Feusner J, Buckley J, Robison L, et al. Prematurity and hepatoblastoma: more than just an association?. J Pediatr. 1998 Oct. 133(4):585-6. [Medline].

  60. Filler RM, Ehrlich PF, Greenberg ML, Babyn PS. Preoperative chemotherapy in hepatoblastoma. Surgery. 1991 Oct. 110(4):591-6; discussion 596-7. [Medline].

  61. Finegold MJ. Chemotherapy for suspected hepatoblastoma without efforts at surgical resection is a bad practice. Med Pediatr Oncol. 2002 Nov. 39(5):484-6. [Medline].

  62. Gutweiler JR, Yu DC, Kim HB, et al. Hepatoblastoma presenting with focal nodular hyperplasia after treatment of neuroblastoma. J Pediatr Surg. 2008 Dec. 43(12):2297-300. [Medline].

  63. Herzog CE, Andrassy RJ, Eftekhari F. Childhood cancers: hepatoblastoma. Oncologist. 2000. 5(6):445-53. [Medline].

  64. Horton JD, Lee S, Brown SR, Bader J, Meier DE. Survival trends in children with hepatoblastoma. Pediatr Surg Int. 2009 May. 25(5):407-12. [Medline].

  65. Kasahara M, Ueda M, Haga H, et al. Living-donor liver transplantation for hepatoblastoma. Am J Transplant. 2005 Sep. 5(9):2229-35. [Medline].

  66. King SJ, Babyn PS, Greenberg ML, Phillips MJ, Filler RM. Value of CT in determining the resectability of hepatoblastoma before and after chemotherapy. AJR Am J Roentgenol. 1993 Apr. 160(4):793-8. [Medline].

  67. Li FP, Thurber WA, Seddon J, Holmes GE. Hepatoblastoma in families with polyposis coli. JAMA. 1987 May 8. 257(18):2475-7. [Medline].

  68. Lopez-Terrada D. Integrating the diagnosis of childhood malignancies. Adv Exp Med Biol. 2006. 587:121-37. [Medline].

  69. Mejia A, Langnas AN, Shaw BW, Torres C, Sudan DL. Living and deceased donor liver transplantation for unresectable hepatoblastoma at a single center. Clin Transplant. 2005 Dec. 19(6):721-5. [Medline].

  70. Meyers RL, Katzenstein HM, Malogolowkin MH. Predictive value of staging systems in hepatoblastoma. J Clin Oncol. 2007 Feb 20. 25(6):737. [Medline].

  71. Mody RJ, Pohlen JA, Malde S, Strouse PJ, Shulkin BL. FDG PET for the study of primary hepatic malignancies in children. Pediatr Blood Cancer. 2006 Jul. 47(1):51-5. [Medline].

  72. Molmenti EP, Wilkinson K, Molmenti H, et al. Treatment of unresectable hepatoblastoma with liver transplantation in the pediatric population. Am J Transplant. 2002 Jul. 2(6):535-8. [Medline].

  73. Mulcahy N. Dramatic Survival Gain in Kids With High-Risk Hepatoblastoma. Medscape Medical News. Aug 15 2013. Available at http://www.medscape.com/viewarticle/809527. Accessed: August 20, 2013.

  74. Otte JB, de Ville de Goyet J. The contribution of transplantation to the treatment of liver tumors in children. Semin Pediatr Surg. 2005 Nov. 14(4):233-8. [Medline].

  75. Otte JB, de Ville de Goyet J, Reding R. Liver transplantation for hepatoblastoma: indications and contraindications in the modern era. Pediatr Transplant. 2005 Oct. 9(5):557-65. [Medline].

  76. Pollock BH, Jenson HB, Leach CT, et al. Risk factors for pediatric human immunodeficiency virus-related malignancy. JAMA. 2003 May 14. 289(18):2393-9. [Medline].

  77. Pritchard J, Brown J, Shafford E, et al. Cisplatin, doxorubicin, and delayed surgery for childhood hepatoblastoma: a successful approach--results of the first prospective study of the International Society of Pediatric Oncology. J Clin Oncol. 2000 Nov 15. 18(22):3819-28. [Medline].

  78. Quinn JJ, Altman AJ, Robinson HT, Cooke RW, Hight DW, Foster JH. Adriamycin and cisplatin for hepatoblastoma. Cancer. 1985 Oct 15. 56(8):1926-9. [Medline].

  79. Raney B. Hepatoblastoma in children: a review. J Pediatr Hematol Oncol. 1997 Sep-Oct. 19(5):418-22. [Medline].

  80. Ranganathan S, Tan X, Monga SP. beta-Catenin and met deregulation in childhood Hepatoblastomas. Pediatr Dev Pathol. 2005 Jul-Aug. 8(4):435-47. [Medline].

  81. Reynolds M, Douglass EC, Finegold M, Cantor A, Glicksman A. Chemotherapy can convert unresectable hepatoblastoma. J Pediatr Surg. 1992 Aug. 27(8):1080-3; discussion 1083-4. [Medline].

  82. Richter A, Grabhorn E, Schulz A, Schaefer HJ, Burdelski M, Ganschow R. Hepatoblastoma in a child with progressive familial intrahepatic cholestasis. Pediatr Transplant. 2005 Dec. 9(6):805-8. [Medline].

  83. Ross JA, Gurney JG. Hepatoblastoma incidence in the United States from 1973 to 1992. Med Pediatr Oncol. 1998 Mar. 30(3):141-2. [Medline].

  84. Sallam A, Paes B, Bourgeois J. Neonatal hepatoblastoma: two cases posing a diagnostic dilemma, with a review of the literature. Am J Perinatol. 2005 Nov. 22(8):413-9. [Medline].

  85. Srinivasan P, McCall J, Pritchard J, et al. Orthotopic liver transplantation for unresectable hepatoblastoma. Transplantation. 2002 Sep 15. 74(5):652-5. [Medline].

  86. [Guideline] Tan TY, Amor DJ. Tumour surveillance in Beckwith-Wiedemann syndrome and hemihyperplasia: a critical review of the evidence and suggested guidelines for local practice. J Paediatr Child Health. 2006 Sep. 42(9):486-90. [Medline].

  87. Tomizawa M, Saisho H. Signaling pathway of insulin-like growth factor-II as a target of molecular therapy for hepatoblastoma. World J Gastroenterol. 2006 Oct 28. 12(40):6531-5. [Medline].

  88. Tomlinson GE, Douglass EC, Pollock BH, Finegold MJ, Schneider NR. Cytogenetic evaluation of a large series of hepatoblastomas: numerical abnormalities with recurring aberrations involving 1q12-q21. Genes Chromosomes Cancer. 2005 Oct. 44(2):177-84. [Medline].

  89. Trobaugh-Lotrario AD, Tomlinson GE, Finegold MJ, Gore L, Feusner JH. Small cell undifferentiated variant of hepatoblastoma: adverse clinical and molecular features similar to rhabdoid tumors. Pediatr Blood Cancer. 2009 Mar. 52(3):328-34. [Medline].

  90. Tsuchida Y, Ikeda H, Suzuki N, et al. A case of well-differentiated, fetal-type hepatoblastoma with very low serum alpha-fetoprotein. J Pediatr Surg. 1999 Dec. 34(12):1762-4. [Medline].

  91. Vogl TJ, Scheller A, Jakob U, Zangos S, Ahmed M, Nabil M. Transarterial chemoembolization in the treatment of hepatoblastoma in children. Eur Radiol. 2006 Jun. 16(6):1393-6. [Medline].

  92. Wang JD, Chang TK, Chen HC, et al. Pediatric liver tumors: initial presentation, image finding and outcome. Pediatr Int. 2007 Aug. 49(4):491-6. [Medline].

  93. Warmann SW, Frank H, Heitmann H, et al. Bcl-2 Gene Silencing in Pediatric Epithelial Liver Tumors. J Surg Res. 2008 Jan. 144(1):43-48. [Medline].

  94. Warmann SW, Heitmann H, Teichmann B, et al. Effects of P-glycoprotein modulation on the chemotherapy of xenotransplanted human hepatoblastoma. Pediatr Hematol Oncol. 2005 Jul-Aug. 22(5):373-86. [Medline].

  95. Zimmermann A. The emerging family of hepatoblastoma tumours: from ontogenesis to oncogenesis. Eur J Cancer. 2005 Jul. 41(11):1503-14. [Medline].

  96. Zsiros J, Brugieres L, Brock P, Roebuck D, Maibach R, Zimmermann A, et al. Dose-dense cisplatin-based chemotherapy and surgery for children with high-risk hepatoblastoma (SIOPEL-4): a prospective, single-arm, feasibility study. Lancet Oncol. 2013 Aug. 14(9):834-42. [Medline]. [Full Text].

 
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Clear cell hepatoblastoma. Hematoxylin and eosin stain. Image courtesy of Denise Malicki, MD.
Embryonal hepatoblastoma. Hematoxylin and eosin stain. Image courtesy of Denise Malicki, MD.
Fetal components of hepatoblastoma. Hematoxylin and eosin stain. Image courtesy of Denise Malicki, MD.
Hepatoblastoma. Normal liver tissue. Hematoxylin and eosin stain. Image courtesy of Denise Malicki, MD.
 
 
 
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