Relapses in hepatoblastoma patients: Clinical characteristics and outcome - Experience of the International Childhood Liver Tumour Strategy Group (SIOPEL)

Purpose: To analyse the clinical characteristics and outcome of hepatoblastoma (HB) patients who relapsed after enrolment on SIOPEL studies 1-3. Patients and methods: Analysis of clinical data of all 59 patients (pts) registered in SIOPEL 1-3 studies, who relapsed after achieving complete remission (CR). Results: The median time from the initial diagnosis to relapse was 12 months (4-115 m). The site of relapse was lung N = 27, liver N = 21, both liver and lung N = 5 and other N = 5 (missing data-MD: 1 patient). All but 9 pts had an alpha-fetoprotein level >10 ng/mL at the time of relapse. Treatment of the relapse included chemotherapy and surgery N = 25, chemotherapy alone N = 21, surgery alone N = 7 and only palliative treatment N = 5 (MD: 1 pt). Overall, 31 pts (52%) achieved a second CR. With a median follow-up of 83 months, 23 pts are alive, (18 in 2nd CR, 5 after a second relapse) and 36 pts have died (35 from disease and 1 from complications). Three-year event-free survival and overall survival are 34% and 43% respectively (95% confidence interval [CI] 0.28-0.69). The main factors associated with a good outcome were PRETEXT group I-III at diagnosis, a high AFP level at relapse and relapse treatment including both chemotherapy and surgery. Conclusion: Relapses in HB are rare events occurring in less than 12% of pts after CR. Combined treatment with chemotherapy and surgical removal of the tumour is essential for long-term survival. (C) 2012 Elsevier Ltd. All rights reserved.