Relapsed hepatoblastoma confined to the lung is effectively treated with pulmonary metastasectomy

BackgroundIn children diagnosed with hepatoblastoma (HB), the lungs are the most common site of metastasis at both initial presentation and relapse. Previous studies have encouraged pulmonary metastasectomy to achieve a disease-free state after resection of the primary hepatic lesion. However, there is no consensus about how to manage recurrent pulmonary metastasis.ProcedureA retrospective, multi-institutional review was performed from 2005 to 2014 to identify HB patients ≤ 18 years of age who had disease recurrence associated with pulmonary metastases alone.ResultsTen patients between the ages of 8 and 33 months were identified. Pulmonary metastatic recurrence was detected by measuring alpha-fetoprotein (AFP) levels and/or with CT scans of the chest. All patients subsequently underwent pulmonary metastasectomy without post-operative complications. At last follow-up, 8 patients were alive and had normal AFP levels. The 8 survivors had a median follow-up from therapy completion of 18.5 months. Two patients who presented with extrapulmonary recurrence subsequently died of treatment refractory disease.ConclusionsThis review supports surgical resection as a safe and, in the context of multimodal therapy, efficacious approach to manage HB patients who present with isolated pulmonary relapse.