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

BACKGROUND: US and European practices differ with respect to treating hepatoblastoma (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.