Characterization of pulmonary metastases in children with hepatoblastoma treated on children’s oncology group protocol AHEP0731 (The treatment of children with all stages of hepatoblastoma): A report from the children’s oncology group

Allison F. O’Neill, Alexander J. Towbin, Mark D. Krailo, Caihong Xia, Yun Gao, M. Beth McCarville, Rebecka L. Meyers, Eugene D. McGahren, Greg M. Tiao, Stephen P. Dunn, Max R. Langham, Christopher B. Weldon, Milton J. Finegold, Sarangarajan Ranganathan, Wayne L. Furman, Marcio Malogolowkin, Carlos Rodriguez-Galindo, Howard M. Katzenstein

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Purpose To determine whether the pattern of lung nodules in children with metastatic hepatoblastoma (HB) correlates with outcome. Methods Thirty-two patients with metastatic HB were enrolled on Children’s Oncology Group Protocol AHEP0731 and treated with vincristine and irinotecan (VI). Responders to VI received two additional cycles of VI intermixed with six cycles of cisplatin/fluorouracil/vincristine/doxorubicin (C5VD), and nonresponders received six cycles of C5VD alone. Patients were imaged after every two cycles and at the conclusion of therapy. All computed tomography scans and pathology reports were centrally reviewed, and information was collected regarding lung nodule number, size, laterality, timing of resolution, and pulmonary surgery. Results Among the 29 evaluable patients, only 31% met Response Evaluation Criteria in Solid Tumors (RECIST) for measurable metastatic disease. The presence of measurable disease by RECIST, the sum of nodule diameters greater than or equal to the cumulative cohort median size, bilateral disease, and $ 10 nodules were each associated with an increased risk for an event-free survival event (P = .48, P = .08, P = .065, P = .03, respectively), with nodule number meeting statistical significance. Ten patients underwent pulmonary resection/metastasectomy at various time points, the benefit of which could not be determined because of small patient numbers. Conclusion Children with metastatic HB have a poor prognosis. Overall tumor burden may be an important prognostic factor for these patients. Lesions that fail to meet RECIST size criteria (ie, those, 10 mm) at diagnosis may contain viable tumor, whereas residual lesions at the end of therapy may constitute eradicated tumor/scar tissue. Patients may benefit from risk stratification on the basis of the burden of lung metastatic disease at diagnosis.

Original languageEnglish (US)
Pages (from-to)3465-3473
Number of pages9
JournalJournal of Clinical Oncology
Volume35
Issue number30
DOIs
StatePublished - Oct 20 2017

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    O’Neill, A. F., Towbin, A. J., Krailo, M. D., Xia, C., Gao, Y., McCarville, M. B., Meyers, R. L., McGahren, E. D., Tiao, G. M., Dunn, S. P., Langham, M. R., Weldon, C. B., Finegold, M. J., Ranganathan, S., Furman, W. L., Malogolowkin, M., Rodriguez-Galindo, C., & Katzenstein, H. M. (2017). Characterization of pulmonary metastases in children with hepatoblastoma treated on children’s oncology group protocol AHEP0731 (The treatment of children with all stages of hepatoblastoma): A report from the children’s oncology group. Journal of Clinical Oncology, 35(30), 3465-3473. https://doi.org/10.1200/JCO.2017.73.5654