Chemotherapy for suspected hepatoblastoma without efforts at surgical resection is a bad practice

Background. US and European practices differ with respect to treating heparoblastoma (HB). Should chemotherapy be given prior to resection in all cases, and even without biopsy confirmation (SIOPEL)? Procedure and Results. US data indicate that 40% of HBs are primarily resectable with no operative mortality and that those with pure fetal histology and low mitotic rate do not require toxic chemotherapy. They also suggest that those with a significant fraction of small undifferentiated cells do not respond to otherwise effective chemotherapy. Both US and European studies report a significant error rate in the clinical and imaging diagnosis of HB. Conclusions. Although only 6.5% of confirmed HBs fall into categories that would be managed differently by US standards, there is no justification for denying those patients a more appropriate treatment nor should the 6-10% of cases that are misdiagnosed as HB be treated incorrectly. (C) 2002 Wiley-Liss, Inc.