Daniel C Aronson1, Víola B Weeda2, Rudolf Maibach3, Piotr Czauderna4, Patrizia Dall'Igna5, Jean de Ville de Goyet6, Sophie Branchereau7, Giorgio Perilongo8, Penelope Brock9, Joszef Zsiros10, Michaela Semeraro11, Christophe Chardot12, Barbara Wildhaber13, Bruce Morland14, Laurence Brugières15. 1. Department of Paediatric Surgery, University Children`s Hospital Zürich, Zürich, Switzerland. Electronic address: dan.aronson@kispi.uzh.ch. 2. Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. 3. IBCSG Coordinating Center, Berne, Switzerland. 4. Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland. 5. Department of Pediatric Surgery, University Hospital of Padua, Padua, Italy. 6. Department of Pediatric Surgery and Transplantation, ISMETT - UPMC, Palermo, Sicile, Italy. 7. Dept. of Pediatric Surgery, APHP Bicêtre Hospital, Le Kremlin-Bicetre, Paris, France. 8. Department of Pediatrics, University Hospital of Padua, Padua, Italy. 9. Department of Pediatrics, Great Ormond Street Hospital for Children, London, United Kingdom. 10. Department of Pediatric Oncology, Máxima Medisch Centrum, Utrecht, the Netherlands. 11. Clinical Research Unit, Paris Centre Necker-Cochin, APHP, Paris, France. 12. Department of Pediatric Surgery, Hopital Universaire Necker Enfants Malade, Paris, France. 13. Department of Pediatric Surgery, Hopiteau Universitaires de Geneve, Geneve, Switzerland. 14. Department of Paediatric Oncology, Birmingham Children's Hospital, Birmingham, United Kingdom. 15. Department of Children and Adolescents Oncology, Gustave Roussy, Villejuif, Paris, France.
Abstract
BACKGROUND: To evaluate the impact of a microscopically positive resection margin (microPRM) on the outcome of hepatoblastoma patients pretreated with chemotherapy. METHODS: Local recurrence and survival rates of 431 children treated in the SIOPEL 2 and 3 trials were analysed comparing 58 patients with microPRM with 371 who had a complete resection (CR) and who were then stratified by risk category. The tumour was standard-risk in 312 patients and high-risk (PRETEXT IV and/or extrahepatic disease and/or α-fetoprotein [AFP]<100 ng/ml) in 117 patients. All received cisplatinum-based neoadjuvant and postoperative chemotherapy as per protocol. Apart from one microPRM patient who went on to transplant, none received any additional local treatment. RESULTS: With a median follow-up of 67 months, local relapse occurred in 3/58 patients with microPRM (5%) and in 23/371 (6%) patients with CR. The 5-year overall survival (OS) was 91% (95% confidence interval [CI] 80%-96%) for the microPRM and 92% (95% CI 89%-95%) for the CR group. The 5-year event-free survival (EFS) was 86% (95% CI 74%-93%) for the microPRM and 86% (95% CI 82%-89%) for the CR group. Neither OS nor EFS was statistically significantly different between the two groups, neither overall nor when risk group stratified. CONCLUSIONS: In the context of cisplatin-based chemotherapy, the presence of microPRM did not influence the outcome even without additional local treatment. Although CR remains the aim, microPRM does not necessitate mandatory second look surgery. A 'wait and see policy' is warranted if postoperative chemotherapy is administered and AFP levels and imaging become normal.
BACKGROUND: To evaluate the impact of a microscopically positive resection margin (microPRM) on the outcome of hepatoblastomapatients pretreated with chemotherapy. METHODS: Local recurrence and survival rates of 431 children treated in the SIOPEL 2 and 3 trials were analysed comparing 58 patients with microPRM with 371 who had a complete resection (CR) and who were then stratified by risk category. The tumour was standard-risk in 312 patients and high-risk (PRETEXT IV and/or extrahepatic disease and/or α-fetoprotein [AFP]<100 ng/ml) in 117 patients. All received cisplatinum-based neoadjuvant and postoperative chemotherapy as per protocol. Apart from one microPRM patient who went on to transplant, none received any additional local treatment. RESULTS: With a median follow-up of 67 months, local relapse occurred in 3/58 patients with microPRM (5%) and in 23/371 (6%) patients with CR. The 5-year overall survival (OS) was 91% (95% confidence interval [CI] 80%-96%) for the microPRM and 92% (95% CI 89%-95%) for the CR group. The 5-year event-free survival (EFS) was 86% (95% CI 74%-93%) for the microPRM and 86% (95% CI 82%-89%) for the CR group. Neither OS nor EFS was statistically significantly different between the two groups, neither overall nor when risk group stratified. CONCLUSIONS: In the context of cisplatin-based chemotherapy, the presence of microPRM did not influence the outcome even without additional local treatment. Although CR remains the aim, microPRM does not necessitate mandatory second look surgery. A 'wait and see policy' is warranted if postoperative chemotherapy is administered and AFP levels and imaging become normal.
Authors: Simone de Campos Vieira Abib; Chan Hon Chui; Sharon Cox; Abdelhafeez H Abdelhafeez; Israel Fernandez-Pineda; Ahmed Elgendy; Jonathan Karpelowsky; Pablo Lobos; Marc Wijnen; Jörg Fuchs; Andrea Hayes; Justin T Gerstle Journal: Ecancermedicalscience Date: 2022-02-17