Recurrence Rate of Hepatoblastoma in Children Following Preoperative Chemotherapy and Surgical Resection

Author(s): Dr. Mahfuz Alam Khan*, Prof A.K.M. Zahid Hossain, Prof. Dr. Susankar Kumar Mondal, Dr. Abdullah All Mahmud, Dr. Umme Habiba Dilshad Munmun, Dr. Md. Shakhawat Islam, Dr Md Raisul Islam, Dr Tanjirul Islam, Dr Syeda Sushmita Zafar

Background: Liver tumors account for 1-2% of childhood cancers, with hepatoblastoma (HB) representing two-thirds of these cases. HB primarily affects children under two years old, often presenting as an asymptomatic abdominal mass. Treatment is challenging, with surgical resection being crucial. The PRETEXT staging system and neoadjuvant chemotherapy are vital in guiding treatment. While advancements have improved the 5-year survival rate for metastatic HB to 79%, about 20% of cases recur, significantly increasing fatality rates. Recurrence remains a significant challenge, highlighting the need for ongoing research to improve longterm outcomes for affected children.

Aim of the study: This study aims to explore the recurrence rate of hepatoblastoma in children following preoperative chemotherapy and surgical resection. Methods: This prospective observational study at BSMMU, Dhaka, Bangladesh, spanned August 2021 to August 2023, involving 12 children with hepatoblastoma, excluding those with lung metastasis. After neoadjuvant chemotherapy following the SIOPEL protocol, patients underwent hepatic resection. Comprehensive clinical and radiological evaluations confirmed diagnoses, including PRETEXT staging and imageguided biopsies. Post-operative care included adjuvant chemotherapy and structured follow-ups. Data on demographics, staging, surgical outcomes, and complications were analyzed using SPSS. The study adhered to ethical standards, ensuring thorough patient counselling, informed consent, and standardized management protocols to optimize treatment outcomes.

Result: This study examined 12 participants with a median age of 22.5 months. The majority were between 13 and 24 months old, with more males than females. PRETEXT stage IIC was the most common. The study noted significant changes in serum bilirubin and S. Transaminase levels post-operation, with fluctuations in AFP levels. Recurrence rates varied by PRETEXT stage and annotation factors: Stage II had a low recurrence rate (12.5%), while stage III had a higher rate (50%). Annotation factor C was associated with a 20% recurrence rate, while factor F had a 50% recurrence rate. The presence of multiple annotation Factors (CF) experienced a 100% recurrence rate.

Conclusion: This study reveals that recurrence in paediatric hepatoblastoma post-chemotherapy and resection is linked to higher PRETEXT stages and specific annotation factors. Elevated serum AFP levels correlate with recurrence, suggesting AFP as a potential biomarker. It highlights the need for careful postoperative monitoring and calls for further research to enhance management strategies.

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