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.
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.
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 1.1 mm 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 1 cm (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.
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.