Intensified Pre-Operative Chemotherapy And Radical Surgery For High Risk Hepatoblastoma

OBJECTIVES:

Primary

• Determine the efficacy and short-term toxicity of intensified neoadjuvant chemotherapy in children with high-risk hepatoblastoma undergoing surgical resection.
• Increase the rate of complete surgical resection in these patients by fully implementing liver transplantation as a valid treatment option for tumor removal when partial liver resection or other surgical options remain unfeasible even after extensive preoperative chemotherapy.
• Determine, prospectively, the role of this regimen in rendering unresectable tumors resectable in these patients.
• Determine the accuracy of initial imaging in predicting the surgical options (after treatment with this regimen) for patients presenting with unresectable disease.

Secondary

• Determine the overall survival and event-free survival of patients treated with this regimen (with an acceptable overall toxicity).
• Determine the toxicity of this regimen in these patients.
• Determine the response rate in patients treated with this regimen.
• Determine whether response to this regimen, defined by the modified RECIST criteria, can be used for better monitoring of response in these patients.
• Determine whether a fall in alpha-fetoprotein during this neoadjuvant regimen can be used as a prognostic factor in these patients.
• Determine, prospectively, radiological, surgical, and pathological characteristics of the tumor that might identify possible novel factors that might influence treatment choice and outcome in these patients.