# Liver Tumors (Hepatoblastoma/HCC) — GCMD Library living collection

Also covered as: hepatoblastoma · hepatocellular carcinoma · metastatic hepatoblastoma · pulmonary metastases · tyrosinemia · neuroblastoma · mesenchymal hamartoma · bronchopulmonary dysplasia

Experts: Dr. Sophia Schermerhorn, Dr. Todd Ponsky, Dr. Em Tombash, Dr. Ellen Encisco

Updated: n/a · 17 episodes · 340 cited statements

## Episodes
### Foundations
- [Hepatoblastoma with Dr. Greg Tiao](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960) — podcast · 10:12 · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960.md)
- [Hepatoblastoma with Dr. Greg Tiao](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256) — video · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256.md)
- [Pediatric Obesity Is a Disease: Treatment, Medications, Surgery & Equity in Care with Dr. Justin Ryder](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602) — video · 6:48 · [machine version](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602.md)

### Medical Management
- [Retreatment with Cisplatin May Provide a Survival Advantage for Children with Relapsed/Refractory Hepatoblastoma: An Institutional Experience](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394) — video · 1:10 · [machine version](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394.md)

### Surgical Management
- [Indocyanine green is a sensitive adjunct in the identification and surgical management of local and metastatic hepatoblastoma](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416) — video · 1:04 · [machine version](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416.md)
- [Characteristics of Transfusion and Association With Oncologic Outcomes in Hepatoblastoma Resection](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811) — video · 1:10 · [machine version](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811.md)

### Evidence & Research
- [Journal of Pediatric Surgery Article Review: June 2022, AAP Issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878) — video · 15:54 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878.md)
- [Journal of Pediatric Surgery Article Review: June 2022, AAP Issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881) — podcast · 15:54 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881.md)
- [BOB Ped Surg 2023 - Andrew Fleming, AAP  - Presentation](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366) — video · [machine version](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366.md)
- [Aggressive Pursuit of No Evidence of Disease Status in Hepatoblastoma Improves Survival](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771) — video · [machine version](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771.md)
- [Journal of Pediatric Article Review: June 2023, AAP Issue](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221) — podcast · 13:57 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221.md)
- [Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371) — video · 1:06 · [machine version](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371.md)

### Case-Based Learning
- [Clinical & Research Update: Pediatric Liver Tumors -  A Case-Based Discussion with Drs. Katherine Somers & Alex Bondoc](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848) — video · 69:23 · [machine version](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848.md)

### In-Depth Reviews
- [Hepatoblastoma: Update Course 2014](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648) — video · 24:43 · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648.md)
- [Hepatoblastoma: Update Course 2014](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882) — video · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882.md)
- [Hepatoblastoma](https://library.globalcastmd.com/watch/hepatoblastoma-291) — podcast · 54:16 · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-291.md)

### Long-Term Care
- [Quality of Life Outcomes for Patients Who Underwent Conventional Resection and Liver Transplantation for Locally Advanced Hepatoblastoma](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423) — video · 1:05 · [machine version](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=0) Cisplatin Retreatment in Relapsed Hepatoblastoma (Ep 12)
- [0:00](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=0) ICG fluorescence imaging in hepatoblastoma surgery (Ep 13)
- [0:00](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=0) Quality of Life Outcomes in Hepatoblastoma Treatment (Ep 14)
- [0:00](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=0) Introduction and Initial Presentation (Ep 3)
- [6:50](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=410) PRETEXT System and Risk Stratification (Ep 3)
- [19:30](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1170) Histologic Subtypes and Treatment Protocols (Ep 3)
- [28:50](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1730) High-Risk Features and Metastatic Disease (Ep 3)
- [36:20](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2180) Surgical Technique and Intraoperative Management (Ep 3)
- [44:40](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2680) Extreme Resections, Transplantation, and Relapse Management (Ep 3)
- [0:01](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=1) Introduction and Disease Framework (Ep 15)
- [1:00](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=60) Paradigm Shift in Treatment Guidelines (Ep 15)
- [2:29](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=149) Treatment Effectiveness and Weight Regain (Ep 15)
- [4:09](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=249) Comorbidities and Health Equity (Ep 15)
- [6:03](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=363) Summary and Closing (Ep 15)
- [0:00](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=0) Introduction and Study Context (Ep 16)
- [0:24](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=24) Study Findings (Ep 16)
- [0:51](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=51) Author Recommendations (Ep 16)
- [3:48](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=228) Case 1 Introduction and Imaging (Ep 17)
- [11:40](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=700) Case 1 Induction Therapy and Atypical Presentations (Ep 17)
- [20:06](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1206) Case 1 Surgical Management (Ep 17)
- [29:16](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1756) Case 1 Pathology and Adjuvant Therapy (Ep 17)
- [36:32](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2192) Case 2 Introduction and Complex Medical History (Ep 17)
- [47:49](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2869) Case 2 Modified Chemotherapy and Transplant Planning (Ep 17)
- [54:54](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3294) Case 2 Transplant Surgery and Pathology (Ep 17)
- [61:41](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3701) Molecular Diagnostics and Future Directions (Ep 17)
- [0:00](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=0) Introduction (Ep 10)
- [1:25](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=85) Short Bowel Syndrome and Bile Acids (Ep 10)
- [4:55](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=295) Hepatoblastoma No-Evidence-of-Disease Status (Ep 10)
- [9:09](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=549) Esophageal Atresia Surveillance (Ep 10)
- [0:00](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=0) Social Determinants and Pediatric Oncology Survival (Ep 11)
- [0:06](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=6) Introduction and Overview (Ep 7)
- [1:49](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=109) Non-Accidental Trauma During COVID-19 (Ep 7)
- [6:22](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=382) Hepatoblastoma Cell Line Development (Ep 7)
- [9:18](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=558) Pulmonary Nodule Localization Techniques (Ep 7)
- [12:26](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=746) Puberty and Growth in Intestinal Failure (Ep 7)
- [15:08](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=908) Closing Remarks (Ep 7)
- [0:06](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=6) Introduction and Overview (Ep 6)
- [1:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=116) Non-Accidental Trauma During COVID-19 (Ep 6)
- [6:22](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=382) Metastatic Hepatoblastoma Cell Line Development (Ep 6)
- [9:18](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=558) Pulmonary Nodule Localization Techniques (Ep 6)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "There is no established standard salvage therapy regimen for relapsed hepatoblastoma" — Sophia Schermerhorn (guideline) [Ep 12 · 0:12](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=12)
- "The Cincinnati Children's retrospective review of 30 patients represents one of the largest published cohorts evaluating patients with refractory or recurrent hepatoblastoma" — Sophia Schermerhorn (epidemiological) [Ep 12 · 0:17](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=17)
- "The overall survival for the cohort was about 50%" — Sophia Schermerhorn (clinical) [Ep 12 · 0:25](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=25)
- "Children who received cisplatin as part of their salvage therapy had survival of about 80% compared to 25% for those who did not receive cisplatin" — Sophia Schermerhorn (clinical) [Ep 12 · 0:28](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=28)
- "The improved survival outcomes with cisplatin may be due to persistent platinum sensitivity or better tumor biology rather than proving causality" — Sophia Schermerhorn (opinion) [Ep 12 · 0:36](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=36)
- "Most patients underwent additional surgery as part of their salvage therapy, either liver resection, liver transplant, or pulmonary metastasectomy" — Sophia Schermerhorn (clinical) [Ep 12 · 0:49](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=49)
- "Salvage therapy for relapsed hepatoblastoma is multimodal" — Sophia Schermerhorn (clinical) [Ep 12 · 0:57](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=57)
- "Cisplatin retreatment should be balanced with the risk of cumulative toxicity" — Sophia Schermerhorn (opinion) [Ep 12 · 0:59](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=59)
- "This is a single institution retrospective review of patients who received ICG prior to either pulmonary metastatectomy or liver resection for hepatoblastoma" — Sophia Schermerhorn (clinical) [Ep 13 · 0:12](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=12)
- "ICG was highly sensitive for detecting hepatoblastoma, about 90%" — Sophia Schermerhorn (clinical) [Ep 13 · 0:22](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=22)
- "In a meaningful number of cases, ICG was able to detect tumor deposits that were not visible, palpable, or detectable on preoperative imaging" — Sophia Schermerhorn (clinical) [Ep 13 · 0:27](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=27)
- "Specificity was lower than sensitivity with false positives" — Sophia Schermerhorn (clinical) [Ep 13 · 0:39](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=39)
- "False positives often represented vascular changes or inflammation" — Sophia Schermerhorn (clinical) [Ep 13 · 0:43](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=43)
- "There were no adverse outcomes associated with any of the additional resections guided by ICG" — Sophia Schermerhorn (clinical) [Ep 13 · 0:46](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=46)
- "ICG was effective in both open and minimally invasive surgery" — Sophia Schermerhorn (clinical) [Ep 13 · 0:50](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=50)
- "ICG was effective in both relapse and primary disease" — Sophia Schermerhorn (clinical) [Ep 13 · 0:50](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=50)
- "This is a single institution cross-sectional study using validated pediatric quality of life surveys to evaluate long-term survivors of hepatoblastoma." — Sophia Schermerhorn (clinical) [Ep 14 · 0:24](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=24)
- "Survival for hepatoblastoma continues to improve." — Sophia Schermerhorn (epidemiological) [Ep 14 · 0:18](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=18)
- "Long-term quality of life is becoming a more important outcome as hepatoblastoma survival improves." — Sophia Schermerhorn (opinion) [Ep 14 · 0:18](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=18)
- "Overall quality of life outcomes were similar between liver transplant and resection groups for hepatoblastoma." — Sophia Schermerhorn (clinical) [Ep 14 · 0:31](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=31)
- "There was no significant difference in emotional, social, physical, or school functioning outcomes between transplant and resection groups." — Sophia Schermerhorn (clinical) [Ep 14 · 0:31](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=31)
- "Patients who underwent resection had lower overall procedure anxiety scores than transplant patients." — Sophia Schermerhorn (clinical) [Ep 14 · 0:47](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=47)
- "The finding of lower procedural anxiety in resection patients was mirrored in the parents' surveys." — Sophia Schermerhorn (clinical) [Ep 14 · 0:53](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=53)
- "Long-term quality of life outcomes appear comparable between patients who undergo resection and liver transplantation for hepatoblastoma." — Sophia Schermerhorn (clinical) [Ep 14 · 0:55](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=55)
- "Surgical strategy for hepatoblastoma can be focused on oncologic control given comparable quality of life outcomes." — Sophia Schermerhorn (opinion) [Ep 14 · 1:02](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=62)
- "Hepatoblastoma presents from the first year of life through perhaps 10 years of age, although there are a few that have been diagnosed older than that" — Max Langham (epidemiological) [Ep 3 · 2:19](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=139)
- "If alpha fetoprotein is quite high and very elevated, the presumptive diagnosis in a 1 year old would be hepatoblastoma" — Max Langham (clinical) [Ep 3 · 2:06](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=126)
- "If it's a rhabdoid tumor, chemotherapy is not important and the lesion needs to be resected" — Max Langham (clinical) [Ep 3 · 2:43](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=163)
- "Most people favor needle biopsy of the liver rather than an open biopsy or a laparoscopic biopsy" — Max Langham (guideline) [Ep 3 · 3:40](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=220)
- "The biopsy should go through the normal part of the liver that will be resected with a specimen, approaching from the side of the tumor to avoid seeding" — Max Langham (clinical) [Ep 3 · 3:51](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=231)
- "Hepatoblastoma will seed and it can create big issues for future resection and cure if you cross the left lobe when the left lobe doesn't have tumor" — Max Langham (clinical) [Ep 3 · 4:06](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=246)
- "There is a predisposition of premature infants to getting hepatoblastomas, usually in the first year or two of life rather than in the nursery" — Max Langham (epidemiological) [Ep 3 · 7:40](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=460)
- "For the biology arm of the children's oncology group, they want 10 core biopsies" — Max Langham (guideline) [Ep 3 · 8:52](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=532)
- "The complication rate and in fact some mortality seems higher with open biopsies than it does with the needle technique" — Max Langham (clinical) [Ep 3 · 9:16](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=556)
- "The overarching goal of treatment for hepatoblastoma is to get the kids to a safe resection" — Max Langham (guideline) [Ep 3 · 10:27](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=627)
- "A PRETEXT 1 lesion has three contiguous sectors of the liver that are free, only possible with lesions in left lateral segment, left lateral sector, or right posterior sector" — Max Langham (clinical) [Ep 3 · 12:50](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=770)
- "PRETEXT 2 is 2 adjoining sectors free, which can happen three ways: right sided lesion with left hemi liver free, left sided lesion with right hemi liver free, or right posterior and left lateral lesions with right anterior and left medial free" — Max Langham (clinical) [Ep 3 · 13:17](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=797)
- "PRETEXT 3 means only one sector is free of disease" — Max Langham (clinical) [Ep 3 · 13:45](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=825)
- "In PRETEXT 4, all sectors are involved with no sectors of the liver free of disease" — Max Langham (clinical) [Ep 3 · 14:00](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=840)
- "Upfront resection is OK if it's a conventional hemihepatectomy or less, with clearly 1 centimeter of normal liver between the middle hepatic vein and the tumor, and no annotation factors" — Max Langham (guideline) [Ep 3 · 14:48](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=888)
- "If it is pure fetal histology after upfront resection, that baby's done with no need for any chemotherapy at all, and survival in that instance is 100%" — Max Langham (clinical) [Ep 3 · 15:37](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=937)
- "Pulmonary metastases make up the vast majority of the metastases in hepatoblastoma, and even small liver tumors can metastasize" — Max Langham (clinical) [Ep 3 · 17:12](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1032)
- "If there are no involvement of the vena cava, confluence of hepatic veins, or portal vein, and the surgeon judges it's resectable at diagnosis, a PRETEXT 1 lesion should be resected with an anatomic resection" — Max Langham (guideline) [Ep 3 · 17:45](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1065)
- "A child that is 8 years of age or older with hepatoblastoma is going to be a significantly higher risk patient" — Max Langham (clinical) [Ep 3 · 29:06](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1746)
- "Metastases always get you to high risk status" — Max Langham (clinical) [Ep 3 · 29:41](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1781)
- "Involvement of vessels will get you to intermediate or high risk" — Max Langham (clinical) [Ep 3 · 29:53](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1793)
- "If the patient has a hepatoblastoma but the alpha fetoprotein is less than 100, that patient's going to be a high risk patient" — Max Langham (clinical) [Ep 3 · 30:18](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1818)
- "Most of the bang that you're going to get with shrinkage of the tumor is going to happen in the first two rounds of chemotherapy" — Max Langham (clinical) [Ep 3 · 26:31](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1591)
- "After 2 rounds of chemotherapy, the surgeon ought to make a commitment whether this is a kid that can be resected or needs referral to transplant" — Max Langham (guideline) [Ep 3 · 26:41](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1601)
- "Multifocal tumors should be referred straight away to a transplant center" — Max Langham (guideline) [Ep 3 · 27:35](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1655)
- "In AHE 0731, patients with mixed fetal-embryonal histology after upfront resection with negative margins were treated with just two courses of cisplatin-based chemotherapy with excellent results" — Max Langham (clinical) [Ep 3 · 24:37](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1477)
- "A child with metastatic lesion in the lung is going to get a total of 6 courses of chemotherapy, and you would like to have them resected no later than the end of the 4th cycle" — Max Langham (guideline) [Ep 3 · 35:08](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2108)
- "Before doing anything of consequence with the liver, make sure you can vascularly isolate the liver by dissecting the suprahepatic and infrahepatic vena cava" — Max Langham (clinical) [Ep 3 · 36:56](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2216)
- "The disasters that have happened during liver resection are because of big time bleeding or because of air embolism" — Max Langham (clinical) [Ep 3 · 37:52](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2272)
- "You want to use a hypovolemic type of anesthesia, preserving transfusions till later in the case and keeping the CVP low, because a high CVP makes the liver swell and bleed more" — Max Langham (clinical) [Ep 3 · 38:52](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2332)
- "You want to take inflow before you get outflow, so you don't want to interrupt the hepatic veins before you control the inflow because the liver will swell" — Max Langham (clinical) [Ep 3 · 39:37](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2377)
- "Liver transplant has great 3 and 5 year disease-free survival but comes at the expense of requiring lifelong immunosuppression with potential for rejection and secondary malignancies" — Max Langham (clinical) [Ep 3 · 42:20](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2540)
- "Extreme resections with vascular reconstruction can provide equivalent oncologic results to transplant without immunosuppression, but have higher complication rates including vascular thrombosis and portal hypertension" — Max Langham (opinion) [Ep 3 · 43:07](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2587)
- "Having a grossly positive margin, getting into an operation and leaving gross residual disease behind is not acceptable" — Max Langham (guideline) [Ep 3 · 44:47](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2687)
- "If they have a negative margin resection and they relapse locally in the liver, refer them for transplantation as salvage transplantation is probably better than re-resection" — Max Langham (guideline) [Ep 3 · 45:36](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2736)
- "Hepatoblastoma is not thought to be radiation sensitive" — Max Langham (clinical) [Ep 3 · 46:32](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2792)
- "After resection following 4 rounds of chemotherapy with clear margins, patients usually have 2 courses of consolidation chemotherapy and then long term follow up for at least 5 years" — Max Langham (guideline) [Ep 3 · 46:53](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2813)
- "Most recurrences will happen within the first 3 years of therapy" — Max Langham (epidemiological) [Ep 3 · 47:02](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2822)
- "In a recent SIOPEL study, nearly half of PRETEXT 4 lesions were resected with conventional resections and did not need liver transplants" — Max Langham (clinical) [Ep 3 · 48:30](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2910)
- "In the US for PRETEXT 4 in AHE 0731, about 90% of those patients were transplanted" — Max Langham (epidemiological) [Ep 3 · 48:44](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2924)
- "Obesity is a disease impacted by behavior and a multifactorial disease impacted by a robust gene-environment interaction" — Justin Ryder (clinical) [Ep 15 · 0:32](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=32)
- "Obesity is influenced by genetics, epigenetics, appetite and satiety hormone dysregulation, stress, economics, adverse life experiences, and environmental factors like calorically dense foods and sedentary lifestyles" — Justin Ryder (clinical) [Ep 15 · 0:44](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=44)
- "About 90% of efforts over the past 50 years have been on prevention of childhood obesity" — Justin Ryder (epidemiological) [Ep 15 · 1:08](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=68)
- "The new AAP clinical practice guidelines clearly state that obesity is a disease" — Justin Ryder (guideline) [Ep 15 · 1:15](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=75)
- "Treatment should be offered to all children above the 85th percentile, and there should be no more watchful waiting" — Justin Ryder (guideline) [Ep 15 · 1:25](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=85)
- "The guidelines describe a non-linear continuum of care starting with intensive health, behavior, and lifestyle treatment involving more than 26 contact hours over a 3 to 12-month period" — Justin Ryder (guideline) [Ep 15 · 1:41](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=101)
- "Pharmacotherapy is FDA labeled for adolescents above the age of 12" — Justin Ryder (guideline) [Ep 15 · 1:55](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=115)
- "There are 5 medications that are FDA approved for the treatment of adolescents with obesity" — Justin Ryder (clinical) [Ep 15 · 2:02](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=122)
- "Bariatric surgery should be considered for those over the age of 13 years old with a BMI 1.2 times the 95th percentile" — Justin Ryder (guideline) [Ep 15 · 2:08](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=128)
- "Wegovy, a GLP-1 receptor agonist, causes about 17% weight loss and is FDA approved in adolescents" — Justin Ryder (clinical) [Ep 15 · 2:29](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=149)
- "Data in adults on tirzepatide shows significant change in body weight compared to placebo" — Justin Ryder (clinical) [Ep 15 · 2:44](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=164)
- "Bariatric surgery studies show sustained weight loss in both adults and adolescent cohorts over several years" — Justin Ryder (clinical) [Ep 15 · 2:51](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=171)
- "There is no difference between Roux-en-Y gastric bypass and vertical sleeve gastrectomy in terms of percent BMI change from baseline over a 10-year period" — Justin Ryder (clinical) [Ep 15 · 3:03](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=183)
- "There is significant heterogeneity in response to bariatric surgery, and weight regain is a significant problem" — Justin Ryder (clinical) [Ep 15 · 3:18](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=198)
- "Bariatric surgery produces substantial improvements in conditions that commonly occur with obesity, like hypertension, diabetes, and high lipids" — Justin Ryder (clinical) [Ep 15 · 3:24](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=204)
- "Weight regain is driven by a balance between behaviors like physical activity and energy intake, and biological factors like energy expenditure and appetite and satiety hormones" — Justin Ryder (clinical) [Ep 15 · 3:40](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=220)
- "Weight regain factors are influenced by genetics and the environment, including puberty, race, and socioeconomic status" — Justin Ryder (clinical) [Ep 15 · 3:56](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=236)
- "It is much easier to lose weight than to keep it off" — Justin Ryder (clinical) [Ep 15 · 4:03](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=243)
- "Metabolic dysfunction associated steatotic liver disease (MASLD) is the most prevalent pediatric liver disease" — Justin Ryder (epidemiological) [Ep 15 · 4:22](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=262)
- "About 20% of youth in the United States have obesity, which is roughly 15 million children" — Justin Ryder (epidemiological) [Ep 15 · 4:34](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=274)
- "Approximately 5 million children have both obesity and MASLD" — Justin Ryder (epidemiological) [Ep 15 · 4:40](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=280)
- "Between 250,000 and 1 million children with obesity and MASLD will progress to cirrhosis and needing a liver transplant or having hepatocellular carcinoma" — Justin Ryder (epidemiological) [Ep 15 · 4:45](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=285)
- "There are racial and ethnic differences in MASLD prevalence" — Justin Ryder (epidemiological) [Ep 15 · 4:56](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=296)
- "Obesity affects at least 35% of adults and 20% of children in Illinois" — Justin Ryder (epidemiological) [Ep 15 · 5:09](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=309)
- "The rates of severe forms of obesity are increasing" — Justin Ryder (epidemiological) [Ep 15 · 5:19](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=319)
- "Obesity significantly increases the risk of long-term health problems and early death" — Justin Ryder (clinical) [Ep 15 · 5:19](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=319)
- "Obesity has substantial economic impact with reductions in GDP and increases in state spending" — Justin Ryder (epidemiological) [Ep 15 · 5:23](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=323)
- "Obesity is a disease driven by biology and it is no one's fault" — Justin Ryder (opinion) [Ep 15 · 5:30](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=330)
- "Access to effective medications is a health equity issue" — Justin Ryder (opinion) [Ep 15 · 5:37](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=337)
- "Obesity disproportionately affects people of color and those living in poverty" — Justin Ryder (epidemiological) [Ep 15 · 5:41](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=341)
- "There is significant variation across the country in how states are covering obesity medications in Medicaid programs" — Justin Ryder (epidemiological) [Ep 15 · 5:49](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=349)
- "It is not uncommon for a patient with hepatoblastoma to need a transfusion during resection" — Jill Knepprath (clinical) [Ep 16 · 0:00](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=0)
- "The study was multi-institutional and published in Pediatric Blood and Cancer in 2025" — Jill Knepprath (epidemiological) [Ep 16 · 0:13](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=13)
- "The study examined how intraoperative transfusion may affect recurrence and survival in hepatoblastoma resection patients" — Jill Knepprath (epidemiological) [Ep 16 · 0:19](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=19)
- "Of those transfused, the majority received red blood cells" — Jill Knepprath (epidemiological) [Ep 16 · 0:25](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=25)
- "Only 11% of transfused patients received platelets" — Jill Knepprath (epidemiological) [Ep 16 · 0:25](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=25)
- "Intraoperative blood transfusions had no effect on recurrence" — Jill Knepprath (clinical) [Ep 16 · 0:32](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=32)
- "Intraoperative blood transfusions were associated with increased death" — Jill Knepprath (clinical) [Ep 16 · 0:32](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=32)
- "There were instances of unnecessary blood transfusions" — Jill Knepprath (clinical) [Ep 16 · 0:39](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=39)
- "Patients who were transfused had higher post-op hemoglobin" — Jill Knepprath (clinical) [Ep 16 · 0:43](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=43)
- "Transfused patients still required more plasma and platelets postoperatively" — Jill Knepprath (clinical) [Ep 16 · 0:43](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=43)
- "The authors think that blood transfusions were mostly red blood cells, and that is what contributed to the post-op coagulopathy" — Jill Knepprath (opinion) [Ep 16 · 0:52](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=52)
- "The authors recommend more careful patient selection for intraoperative transfusions" — Jill Knepprath (guideline) [Ep 16 · 1:00](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=60)
- "The authors recommend a balanced transfusion approach" — Jill Knepprath (guideline) [Ep 16 · 1:00](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=60)
- "Rib fractures or vertebral fractures are fairly common as a presentation factor with hepatic tumors in young children, particularly hepatoblastoma" — Katherine Somers (clinical) [Ep 17 · 14:51](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=891)
- "Fractures will heal as children go through their therapy, and kids are remarkable in their resilience and tend to be rather unbothered by their fractures once cancer therapy is underway" — Katherine Somers (clinical) [Ep 17 · 15:29](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=929)
- "Precocious puberty in a Tanner stage one patient is a sign that should prompt consideration of underlying malignancy on the differential" — Katherine Somers (clinical) [Ep 17 · 15:43](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=943)
- "MRI using a hepatobiliary contrast agent is the first-line imaging study for patients with a liver tumor, allowing better visualization of multifocal disease and ideal assessment of hepatic vasculature" — Alex Tobin (guideline) [Ep 17 · 7:51](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=471)
- "PRETEXT criteria define metastatic disease as more than 2 nodules greater than 3 millimeters in diameter or 1 nodule greater than 5 millimeters in diameter" — Alex Tobin (guideline) [Ep 17 · 38:39](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2319)
- "High-risk therapy for hepatoblastoma includes cisplatin and doxorubicin, with dexrazoxane cardiac protectant given institutionally with doxorubicin" — Katherine Somers (clinical) [Ep 17 · 18:38](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1118)
- "Weight loss or sarcopenia during active cancer therapy is associated with poor outcomes across all pediatric cancer diagnoses" — Katherine Somers (epidemiological) [Ep 17 · 19:39](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1179)
- "Almost every young toddler with a large liver tumor requires aggressive nutritional support to get through intensive therapy and surgical procedures" — Katherine Somers (clinical) [Ep 17 · 19:18](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1158)
- "Maximum tumor shrinkage typically occurs after the first block or cycle of chemotherapy; subsequent blocks produce less shrinkage" — Alex Bondoc (clinical) [Ep 17 · 24:34](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1474)
- "ICG fluorescence is highly sensitive but not specific for tumor detection; it can help find multifocal disease and assess margins" — Alex Bondoc (clinical) [Ep 17 · 26:05](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1565)
- "In approximately 15% of lung resections, ICG fluorescence identifies lesions not visible on high-resolution axial imaging" — Alex Bondoc (clinical) [Ep 17 · 26:21](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1581)
- "The FIT trial (AHEP 1531) mandated liver biopsy for diagnosis before starting treatment" — Ranga (Ranganathan) (guideline) [Ep 17 · 30:05](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1805)
- "Post-chemotherapy tumor response is maximum in initial stages; once tumor is replaced by blood pools and fibrous tissue, size doesn't decrease much further" — Ranga (Ranganathan) (clinical) [Ep 17 · 33:04](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1984)
- "Even when first-side chest metastases show no viable tumor, the other side is still cleared surgically because combined chemotherapy and surgical clearance is the best pathway to cure" — Katherine Somers (guideline) [Ep 17 · 39:20](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2360)
- "Patients with hepatoblastoma are frequently born prematurely" — Alex Tobin (epidemiological) [Ep 17 · 45:07](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2707)
- "End-stage renal disease early in life shows increased incidence of hepatoblastoma, not just autosomal recessive polycystic kidney disease" — Katherine Somers (epidemiological) [Ep 17 · 49:18](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2958)
- "Cisplatin's primary toxicity is renal, and platinum excretion is fully dependent on a functioning renal system" — Katherine Somers (clinical) [Ep 17 · 49:39](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2979)
- "Patients on peritoneal dialysis can receive platinum chemotherapy using advanced pharmacokinetic and pharmacodynamic modeling without typical mandated hyperhydration" — Katherine Somers (clinical) [Ep 17 · 50:02](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3002)
- "For known predisposition patients, screening protocol starts with ultrasound and alpha-fetoprotein levels, accounting for different normal AFP ranges in first months of life" — Katherine Somers (guideline) [Ep 17 · 51:20](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3080)
- "PRETEXT IV multifocal disease requires liver transplantation; patients should be referred early to transplant program" — Alex Bondoc (guideline) [Ep 17 · 52:15](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3135)
- "In the United States, children with hepatoblastoma automatically receive Status 1B categorization on deceased donor list, the second highest stratum for organ allocation" — Alex Bondoc (guideline) [Ep 17 · 59:46](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3586)
- "Conventional hepatoblastoma is genomically quiet with very low mutation burden and invariably has point mutation or small deletion in exon 3 of CTNNB1 gene" — Ranga (Ranganathan) (clinical) [Ep 17 · 62:23](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3743)
- "Hepatocellular neoplasm NOS shows more genomic instability with chromosomal gains and losses, characterized by CTNNB1 deletion, often large deletions or complete exon 3 skipping" — Ranga (Ranganathan) (clinical) [Ep 17 · 62:41](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3761)
- "Beta-catenin immunohistochemistry is frequently weak positive or negative in HCC-NOS, serving as a diagnostic clue along with pleomorphic appearance and macrotrabecular arrangement" — Ranga (Ranganathan) (clinical) [Ep 17 · 63:19](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3799)
- "HCC-NOS can be targeted with high-risk hepatoblastoma therapy to shrink tumors and make them amenable to surgery in most cases" — Ranga (Ranganathan) (clinical) [Ep 17 · 63:51](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3831)
- "Every child with new cancer diagnosis meets with genetic counseling oncology team for complete genetic testing including germline testing if something is identified" — Katherine Somers (guideline) [Ep 17 · 65:03](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3903)
- "Radiomics can predict pure fetal histology hepatoblastoma with area under ROC curve of approximately 0.85" — Alex Tobin (clinical) [Ep 17 · 66:36](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3996)
- "Pure fetal histology hepatoblastoma patients are cured with resection alone and don't need chemotherapy" — Alex Tobin (clinical) [Ep 17 · 66:58](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=4018)
- "Artificial intelligence can segment liver tumors very accurately at the level of an expert" — Alex Tobin (clinical) [Ep 17 · 67:13](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=4033)
- "Tumor board presentation and multidisciplinary conference approach is associated with improved success and long-term outcomes for pediatric liver tumor patients" — Alex Bondoc (epidemiological) [Ep 17 · 23:04](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1384)
- "AAP stands for American Academy of Pediatrics" — Em Tombash (clinical) [Ep 10 · 0:28](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=28)
- "Patients with distal resection in short bowel syndrome had a protective effect on liver injuries" — Cecilia Gigena (clinical) [Ep 10 · 2:39](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=159)
- "Proximal small bowel resection results in greater oxidative stress in the liver, evidenced by elevated messenger RNA transcripts for tumor necrosis factor A, NADPH oxidase and glutathione synthase" — Colin Martin (clinical) [Ep 10 · 3:02](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=182)
- "The ileocecal region may not be important to preserve and may actually be injurious" — Brad Warner (clinical) [Ep 10 · 3:28](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=208)
- "Administration of a specific bile acid that is more lipophilic and hepatoprotective could be potential therapy for patients with cholestatic liver disease after massive intestinal resection" — Brad Warner (clinical) [Ep 10 · 3:37](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=217)
- "In clinical practice, surgeons cannot choose which segment of intestine to remove - they must remove what's dead and preserve as much as possible" — Brad Warner (clinical) [Ep 10 · 4:13](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=253)
- "82% of hepatoblastoma patients (41 out of 50) were able to achieve NED status" — Colin Martin (clinical) [Ep 10 · 6:23](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=383)
- "14 high-risk hepatoblastoma patients underwent a median of 2.5 pulmonary metastasectomies" — Em Tombash (clinical) [Ep 10 · 6:40](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=400)
- "5 high-risk hepatoblastoma patients relapsed and 3 of them were saved" — Em Tombash (clinical) [Ep 10 · 6:50](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=410)
- "Once no evidence of disease status was achieved, the 10-year overall survival among high-risk patients was similar to patients that were not high risk" — Andrew Fleming (clinical) [Ep 10 · 7:10](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=430)
- "There is no threshold for disease burden that precludes aggressive pursuit of no evidence of disease in children with hepatoblastoma" — Andrew Fleming (clinical) [Ep 10 · 8:06](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=486)
- "The survey had a 77% response rate from 181 physicians at 19 institutions" — Colin Martin (epidemiological) [Ep 10 · 9:56](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=596)
- "Only 36% of institutions claimed to perform routine upper GI endoscopy regardless of symptoms in esophageal atresia patients" — Colin Martin (epidemiological) [Ep 10 · 10:03](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=603)
- "Without proper surveillance, esophageal atresia patients could be at risk for esophageal cancer and chronic dysmotility" — Colin Martin (clinical) [Ep 10 · 10:52](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=652)
- "The way to get esophageal atresia surveillance done is to have a formal aerodigestive team" (opinion) [Ep 10 · 12:20](https://library.globalcastmd.com/watch/journal-of-pediatric-article-review-june-2023-aap-issue-7221?t=740)
- "Study was a retrospective analysis of 12,000 patients with neuroblastoma, Wilms tumor, and hepatoblastoma from the National Cancer Database" — Sophia Schermerhorn (epidemiological) [Ep 11 · 0:12](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=12)
- "Socioeconomic disadvantage score was created for each patient based on median household income and education level in their local communities" — Sophia Schermerhorn (epidemiological) [Ep 11 · 0:20](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=20)
- "The most disadvantaged children were more likely to have worse survival for Wilms tumor and neuroblastoma" — Sophia Schermerhorn (epidemiological) [Ep 11 · 0:31](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=31)
- "After adjusting for tumor size, grade, treatment, and comorbidities, socioeconomic effects on survival remained present" — Sophia Schermerhorn (epidemiological) [Ep 11 · 0:37](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=37)
- "Hazard ratio for socioeconomic disadvantage was 2.02 for Wilms tumor" — Sophia Schermerhorn (epidemiological) [Ep 11 · 0:44](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=44)
- "Hazard ratio for socioeconomic disadvantage was 1.29 for hepatoblastoma" — Sophia Schermerhorn (epidemiological) [Ep 11 · 0:44](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=44)
- "Pediatric oncology outcomes depend on tumor biology, treatment received, and social determinants of health" — Sophia Schermerhorn (opinion) [Ep 11 · 0:51](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=51)
- "Identifying socioeconomic risk factors is necessary to close equity gaps and improve survival for all children with solid tumors" — Sophia Schermerhorn (opinion) [Ep 11 · 1:00](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=60)
- "The Midwest Pediatric Surgery Research Consortium was established by departments of Pediatric Surgery from 11 children's hospitals" — Ellen Incisco and M. Tom Bash (epidemiological) [Ep 7 · 2:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=135)
- "Non-accidental trauma rates initially dropped during stay-at-home orders but subsequently increased above expected levels" — Nicole Chandler (epidemiological) [Ep 7 · 4:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=256)
- "Patients disproportionately affected by increased non-accidental trauma were older children (>5 years), minority children, and lower socioeconomic groups as determined by social vulnerability index" — Nicole Chandler (epidemiological) [Ep 7 · 4:31](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=271)
- "CDC Social Vulnerability Index was created to assess neighborhood vulnerability during times of crises" — Ellen Incisco and M. Tom Bash (guideline) [Ep 7 · 5:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=312)
- "During public health crises, it is important to maintain systems of protection for children who lose normal protections from school" — Nicole Chandler (opinion) [Ep 7 · 5:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=337)
- "Trauma registry data and ICD-10 codes have limitations that require caution in drawing strong conclusions" — Ellen Incisco and M. Tom Bash (clinical) [Ep 7 · 5:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=356)
- "Very few cell lines are available to study hepatoblastoma, and some cell lines labeled as hepatoblastoma are actually hepatocellular carcinoma" — Ellen Incisco and M. Tom Bash (clinical) [Ep 7 · 6:47](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=407)
- "Management of metastatic hepatoblastoma continues to pose significant treatment challenges" — Nicole Chandler (clinical) [Ep 7 · 7:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=433)
- "The new metastatic hepatoblastoma cell line was created by serial passage through mouse lungs, harvesting lung tissue, culturing surviving cells, and repeating the process" — Ellen Incisco and M. Tom Bash (clinical) [Ep 7 · 7:24](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=444)
- "The new hepatoblastoma cell line exhibited increased tumorigenicity, invasiveness, and increased resistance to chemotherapy compared to the original human cell line" — Nicole Chandler (clinical) [Ep 7 · 8:14](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=494)
- "PSORC (Pediatric Surgical Oncology Research Collaborative) is a multi-institutional consortium of North American pediatric surgeons focused on advancing care of children with cancer" — Marcus Malik (clinical) [Ep 7 · 9:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=586)
- "There has been no consistency in localization techniques for small pulmonary nodules across institutions" — Marcus Malik (clinical) [Ep 7 · 10:19](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=619)
- "The most common localization techniques for pulmonary nodules are wire and methylene blue dye, followed by methylene blue dye only" — Nicole Chandler (clinical) [Ep 7 · 10:49](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=649)
- "There was no difference in successful IR localization or successful resection of pulmonary nodules between different localization techniques" — Nicole Chandler (clinical) [Ep 7 · 10:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=656)
- "Time under anesthesia for nodule localization can be long and variable depending on institutional setup (hybrid OR vs separate IR suite)" — Marcus Malik (clinical) [Ep 7 · 11:10](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=670)
- "Experience is probably more important than the actual localization technique itself, given all techniques were wildly successful" — Nicole Chandler (opinion) [Ep 7 · 12:06](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=726)
- "Pediatric intestinal failure was defined as requirement of parenteral nutrition for 60 days or more at any time before 8 years of age" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 7 · 12:52](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=772)
- "Puberty is at least partially dependent on having good nutritional stores based on hormonal drivers" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 7 · 13:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=818)
- "The hypothesis was that chronic pediatric intestinal failure would delay puberty and potentially dull the sharp spike of peak height velocity" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 7 · 13:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=825)
- "Peak height velocity occurred at significantly younger ages for both males and females with intestinal failure" — Nicole Chandler (clinical) [Ep 7 · 14:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=840)
- "Puberty onset occurred significantly earlier compared to established norms for males with intestinal failure, reaching pubertal onset earlier than the CDC 50th percentile" — Nicole Chandler (clinical) [Ep 7 · 14:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=840)
- "There is a high incidence of short stature in chronic intestinal failure" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 7 · 14:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=877)
- "The finding that short stature is not due to missing pubertal timing suggests the need to do a better job at setting up intestinal failure patients for puberty by working on their height and linear growth beforehand" — Todd Ponsky and Dr. Biran Modi (opinion) [Ep 7 · 14:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=877)
- "The Midwest Pediatric Surgery Research Consortium was established by departments of Pediatric Surgery from 11 children's hospitals" — Ellen Incisco and M. Tom Bash (clinical) [Ep 6 · 2:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=135)
- "The study used historical patterns of NAT captured by trauma registries to predict what the volume should have been during the initial COVID time period and compared that to observed rates" — Ellen Incisco and M. Tom Bash (clinical) [Ep 6 · 3:42](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=222)
- "NAT rates initially dropped slightly but then increased above expected levels during stay-at-home orders" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 6 · 4:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=247)
- "Patients disproportionately affected were older children over 5 years who would commonly be in school, minority children, and lower socioeconomic groups as determined by social vulnerability index" — Nicole Chandler (epidemiological) [Ep 6 · 4:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=267)
- "The CDC Social Vulnerability Index was created to assess a neighborhood's vulnerability during times of crises" — Ellen Incisco and M. Tom Bash (clinical) [Ep 6 · 5:12](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=312)
- "During public health crises, it is important to maintain systems of protection for children, particularly when they are not afforded normal protections from school" — Nicole Chandler (opinion) [Ep 6 · 5:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=337)
- "One must be careful not to make too strong conclusions based on trauma registry data and ICD-10 codes, regardless of the number of institutions or evaluation period length" — Ellen Incisco and M. Tom Bash (opinion) [Ep 6 · 6:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=367)
- "Very few cell lines are available to study hepatoblastoma, and some cell lines touted as hepatoblastoma are actually hepatocellular carcinoma" — Ellen Incisco and M. Tom Bash (clinical) [Ep 6 · 6:47](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=407)
- "Management of metastatic hepatoblastoma continues to pose significant treatment challenges" — Nicole Chandler (clinical) [Ep 6 · 7:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=433)
- "The new metastatic hepatoblastoma cell line was created by labeling cells with luciferase, injecting them into mouse tail veins where they preferentially metastasized to lungs, harvesting and culturing surviving cells, and repeating the process until establishing a reliable metastatic cell line" — Ellen Incisco and M. Tom Bash (clinical) [Ep 6 · 7:24](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=444)
- "The new cell line exhibited increased tumorigenicity, invasiveness, and increased resistance to chemotherapy compared to the original human cell line" — Nicole Chandler (clinical) [Ep 6 · 8:14](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=494)
- "There was no hepatoblastoma cell line mouse model available before this study" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 6 · 8:29](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=509)
- "PSORC is the Pediatric Surgical Oncology Research Collaborative, a multi-institutional consortium of North American pediatric surgeons focused on advancing care of children with cancer" — Marcus Malik (clinical) [Ep 6 · 9:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=586)
- "PSORC was founded to amalgamate data from multiple institutions to better study surgical questions in pediatric cancer" — Marcus Malik (clinical) [Ep 6 · 10:05](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=605)
- "There has not been consistency in localization techniques for small pulmonary nodules across North American institutions" — Marcus Malik (clinical) [Ep 6 · 10:19](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=619)
- "The most common localization techniques were wire and methylene blue dye, followed by methylene blue dye only" — Nicole Chandler (clinical) [Ep 6 · 10:49](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=649)
- "There was no difference in successful IR localization or successful resection of pulmonary nodules between different localization techniques" — Nicole Chandler (clinical) [Ep 6 · 10:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=656)
- "Time under anesthesia for localization procedures can be long and variable depending on institutional setup, with some using hybrid ORs for immediate transition from localization to operation" — Marcus Malik (clinical) [Ep 6 · 11:10](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=670)
- "Experience is probably more important than the actual localization technique itself, given that all techniques were wildly successful despite significant variation" — Nicole Chandler (opinion) [Ep 6 · 12:06](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=726)
- "Pediatric intestinal failure was defined as requirement of parenteral nutrition for 60 days or more at any time, with diagnosis before 8 years of age" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 6 · 12:52](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=772)
- "Puberty is at least partially dependent on having good nutritional stores based on hormonal drivers of puberty" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 6 · 13:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=818)
- "The hypothesis was that chronic pediatric intestinal failure would delay puberty and potentially dull the sharp spike of peak height velocity" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 6 · 13:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=825)
- "Peak height velocity occurred at significantly younger ages for both males and females with intestinal failure" — Nicole Chandler (clinical) [Ep 6 · 14:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=840)
- "Puberty onset occurred significantly earlier compared to established norms for males, reaching pubertal onset earlier than the CDC 50th percentile" — Nicole Chandler (clinical) [Ep 6 · 14:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=840)
- "There is a high incidence of short stature in chronic intestinal failure" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 6 · 14:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=877)
- "The finding that short stature is not due to missing pubertal timing or peak height velocity suggests the need to better optimize height and linear growth before puberty" — Todd Ponsky and Dr. Biran Modi (clinical) [Ep 6 · 14:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=877)
- "PRETEXT staging stands for pre-treatment extent of disease and is based on segmental liver anatomy prior to chemotherapy" (guideline) [Ep 1 · 2:02](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=122)
- "PRETEXT staging has a tendency to overstage because it is based purely on imaging and bulky tumors make it hard to assess true vascular invasion versus mass effect" (clinical) [Ep 1 · 2:28](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=148)
- "POSTTEXT refers to extent of disease after neoadjuvant chemotherapy has been given" (guideline) [Ep 1 · 2:51](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=171)
- "The two key annotations in PRETEXT staging are involvement of the retrohepatic cava or hepatic veins and involvement of the portal vein bifurcation" (guideline) [Ep 1 · 4:07](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=247)
- "COG recommendations state that PRETEXT 2 tumors without vascular involvement and with achievable 1 cm margins should proceed to upfront hepatectomy" (guideline) [Ep 1 · 7:41](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=461)
- "COG feels that PRETEXT 1 and 2 tumors can be resected locally if the surgeon feels competent and do not necessarily require referral to centers with liver resection expertise" (guideline) [Ep 1 · 8:05](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=485)
- "Most tumor volume shrinkage with chemotherapy occurs within the first 2 cycles" (clinical) [Ep 1 · 10:14](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=614)
- "Current recommendations are that after 2 cycles of chemotherapy, if the tumor has not shrunk to a resectable point, the patient should be evaluated for transplant" (guideline) [Ep 1 · 10:33](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=633)
- "As hepatoblastoma tumors shrink with chemotherapy, they do not shrink away from the vascular supply significantly - they shrink in size but preserve similar vascular relationships" (clinical) [Ep 1 · 11:06](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=666)
- "Survival after very extensive or heroic resections (tumor liver explants with back table resections and reimplants, portal vein reconstructions, hepatic vein reconstructions) is not as good as transplant survival" (clinical) [Ep 1 · 12:10](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=730)
- "There has been a move away from heroic resections based on survival data" (opinion) [Ep 1 · 12:40](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=760)
- "Rescue transplants after failed resection have significantly worse outcomes than planned primary transplants" (clinical) [Ep 1 · 14:09](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=849)
- "Current thinking is to refer to transplant center early, which does not necessarily mean the patient will go to transplant but allows pre-transplant evaluation and system integration" (guideline) [Ep 1 · 14:36](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=876)
- "Primary transplant patients do surprisingly well despite immunosuppression for cancer" (clinical) [Ep 1 · 15:13](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=913)
- "In the UK, all complex liver resections for hepatoblastoma are done in centers that do pediatric liver transplants" (epidemiological) [Ep 1 · 15:57](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=957)
- "The imaging goal for resection is a 1 centimeter margin" (guideline) [Ep 1 · 11:32](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=692)
- "North American and European approaches to hepatoblastoma management are converging" (epidemiological) [Ep 1 · 9:32](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=572)
- "There are approximately 100 hepatoblastomas per year in the United States" (epidemiological) [Ep 1 · 9:47](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=587)
- "The only way to make progress with hepatoblastoma is through combined approaches with European groups" (opinion) [Ep 1 · 10:03](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=603)
- "Despite all available imaging, the truth about resectability is determined at the time of operation" (clinical) [Ep 1 · 19:43](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1183)
- "In Europe, all liver tumors receive chemotherapy up front before surgery because it results in smaller tumors and may avoid transplantation" (epidemiological) [Ep 1 · 19:58](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1198)
- "For core needle biopsies of hepatoblastoma, approximately 10 passes are recommended through an area that includes normal parenchyma and tumor" (guideline) [Ep 1 · 21:25](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1285)
- "There is debate over whether to resect pulmonary metastases before or after hepatectomy, with one camp concerned that liver regeneration growth factors may stimulate previously unrecognized lung disease" (opinion) [Ep 1 · 22:11](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1331)
- "Data on pulmonary metastases management is limited to a handful of patients on both sides with no good conclusions possible" (epidemiological) [Ep 1 · 22:45](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1365)
- "There may be reporting bias in transplant outcomes because successes are reported but not all failures" (opinion) [Ep 1 · 23:38](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1418)
- "PRETEXT staging stands for pretreatment extent of disease and is based on segmental liver anatomy prior to chemotherapy" (clinical) [Ep 2 · 1:41](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=101)
- "PRETEXT staging has a tendency to overstage because it is based purely on imaging and bulky tumors make it hard to assess true vascular invasion versus mass effect" (clinical) [Ep 2 · 1:41](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=101)
- "POSTTEXT refers to extensive disease after neoadjuvant chemotherapy has been given" (clinical) [Ep 2 · 1:41](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=101)
- "Key staging annotations include involvement of the retrohepatic cava or hepatic veins and the portal vein bifurcation" (clinical) [Ep 2 · 3:52](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=232)
- "COG recommendations state that PRETEXT stage 2 tumors with no vascular involvement and achievable 1 cm margin can be resected upfront without neoadjuvant chemotherapy" (guideline) [Ep 2 · 7:30](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=450)
- "COG feels that PRETEXT stage 1 and 2 tumors do not necessarily need referral to centers with liver resection expertise if the local surgeon feels competent" (guideline) [Ep 2 · 7:55](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=475)
- "Most tumor shrinkage from chemotherapy occurs within the first two cycles" (clinical) [Ep 2 · 10:26](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=626)
- "Current recommendations are that after two cycles of chemotherapy, if the tumor has not shrunk to a resectable point, the patient should be evaluated for transplant" (guideline) [Ep 2 · 10:26](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=626)
- "As hepatoblastoma tumors shrink with chemotherapy, they do not shrink away from the vascular supply, so chemotherapy does not improve vascular margins" (clinical) [Ep 2 · 10:26](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=626)
- "The goal surgical margin for hepatoblastoma resection is 1 cm" (clinical) [Ep 2 · 12:08](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=728)
- "Survival in patients undergoing extended or heroic resections (tumor liver explants with back table resection and reimplant, portal vein reconstructions, hepatic vein reconstructions) is not as good as transplant survival" (clinical) [Ep 2 · 12:33](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=753)
- "There has been a move away from heroic resections for hepatoblastoma" (opinion) [Ep 2 · 12:33](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=753)
- "Patients who undergo failed resection followed by rescue transplant have worse survival than patients who undergo planned transplant upfront" (clinical) [Ep 2 · 14:52](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=892)
- "Patients should be referred to a transplant center early even if they may not ultimately need transplant, to have pre-transplant evaluation completed and be plugged into the system" (guideline) [Ep 2 · 15:48](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=948)
- "Primary transplant patients with hepatoblastoma do surprisingly well despite immunosuppression against rejection in the setting of cancer" (clinical) [Ep 2 · 16:38](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=998)
- "For non-transplant center surgeons, criteria for proceeding with resection include feeling 95% confident of success and ability to perform an anatomic resection with good margin" (opinion) [Ep 2 · 18:56](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1136)
- "Disease close to hepatic veins, disease extending across the liver, or involvement of the portal vein should prompt referral to a transplant center" (opinion) [Ep 2 · 19:54](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1194)
- "The truth about resectability is determined at the time of operation despite all available imaging" (opinion) [Ep 2 · 21:52](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1312)
- "In Europe, all liver tumors receive chemotherapy upfront before surgery because it results in smaller, easier-to-resect tumors" (clinical) [Ep 2 · 22:13](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1333)
- "Core needle biopsy for hepatoblastoma typically requires about 10 passes through an area that includes normal parenchyma and tumor" (clinical) [Ep 2 · 23:53](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1433)
- "There are two camps regarding pulmonary metastasis treatment: one advocates resecting metastases upfront before hepatectomy, the other suggests waiting until after hepatectomy because liver regeneration growth factors may stimulate previously unrecognized lung sites" (clinical) [Ep 2 · 24:49](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1489)
- "There is no good data on either side of the pulmonary metastasis timing debate, with both approaches limited to a handful of patients" (opinion) [Ep 2 · 24:49](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1489)
- "Papers on stage IV hepatoblastoma with lung metastases are limited to cohorts of less than 20 patients, making it hard to draw good conclusions" (epidemiological) [Ep 2 · 26:11](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1571)
- "There may be reporting bias in transplant outcomes because successes are reported but not all failures" (opinion) [Ep 2 · 26:11](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1571)
- "Hepatoblastoma is the most common malignant liver tumor in the pediatric population" (epidemiological) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=0)
- "There are around 250 new cases of hepatoblastoma per year" (epidemiological) [Ep 5 · 0:20](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=20)
- "Treatment strategies for hepatoblastoma have changed dramatically over the past 25 years" (clinical) [Ep 5 · 0:10](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=10)
- "Hepatoblastoma is nowhere near the most common liver tumor or the most common abdominal tumor in children" — Greg Tiao (epidemiological) [Ep 5 · 0:46](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=46)
- "Neuroblastoma is the most common solid malignancy in the pediatric population" (epidemiological) [Ep 5 · 1:14](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=74)
- "Hemangioma is the most common liver lesion in children" (epidemiological) [Ep 5 · 1:40](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=100)
- "Hepatoblastoma can present as an asymptomatic abdominal mass, tumor rupture, or respiratory distress due to tumor size" — Greg Tiao (clinical) [Ep 5 · 2:20](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=140)
- "Hepatoblastoma can present as a paraneoplastic syndrome like precocious puberty" (clinical) [Ep 5 · 2:46](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=166)
- "An elevated alpha fetoprotein (AFP) is a key component in the workup and is critical for the diagnostic algorithm and treatment response" (clinical) [Ep 5 · 2:46](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=166)
- "Most experts rely on MRI to delineate anatomy and evaluate the extent of liver involvement in hepatoblastoma" — Greg Tiao (clinical) [Ep 5 · 3:13](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=193)
- "Eovist is an MRI contrast agent taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging" — Greg Tiao (clinical) [Ep 5 · 3:13](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=193)
- "To establish a diagnosis of hepatoblastoma, four things are needed: history, abdominal imaging, AFP check, and liver biopsy" (clinical) [Ep 5 · 3:39](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=219)
- "The most important intervention for survival is to achieve complete resection" (clinical) [Ep 5 · 3:39](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=219)
- "Aggressive resections include trisectionectomy, mesohepatectomy, resection with additional procedure in remnant liver, and liver transplantation" — Greg Tiao (clinical) [Ep 5 · 4:25](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=265)
- "Couinaud labeled liver segments in a counterclockwise fashion by injecting portal vessels, similar to how districts of Paris are labeled" (clinical) [Ep 5 · 4:50](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=290)
- "The right hepatic vein differentiates anterior and posterior sections of the right liver" — Greg Tiao (clinical) [Ep 5 · 5:41](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=341)
- "The right portal vein separates superior and inferior segments of the right liver" — Greg Tiao (clinical) [Ep 5 · 6:02](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=362)
- "The pre-text staging system classifies tumors based on the number of contiguous liver sections free of disease (minus four equals pre-text stage)" — Greg Tiao (clinical) [Ep 5 · 6:51](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=411)
- "Pre-text 1 has three contiguous sections free of disease, pre-text 2 has two, pre-text 3 has one, and pre-text 4 has no free sections or diffuse tumor" — Greg Tiao (clinical) [Ep 5 · 6:51](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=411)
- "Pre-text 1 and 2 tumors with greater than 1 cm margin from middle hepatic vein and portal bifurcation should be considered for resection at diagnosis" (clinical) [Ep 5 · 8:01](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=481)
- "Pre-text 3 and 4 tumors represent a big game changer in practice that improved survival from less than 30% in the 1970s-80s to 80-90% today" — Greg Tiao (clinical) [Ep 5 · 8:15](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=495)
- "Pre-text 3 tumors should generally be biopsied at diagnosis, started on neoadjuvant chemotherapy, then referred to transplant center or center with expertise in advanced liver resections" — Greg Tiao (clinical) [Ep 5 · 8:15](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=495)
- "Indications for transplant in pre-text 3 or 4 disease include unresectable disease, unsafe resection, or inadequate liver remnant" (clinical) [Ep 5 · 9:12](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=552)
- "It is important to consult a transplant center early for pre-text 3 and 4 tumors" — Greg Tiao (clinical) [Ep 5 · 9:35](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=575)
- "The PHITT (Pediatric Hepatic International Tumor Trial) is an ongoing multinational trial to identify high and low risk features for each pre-text stage" — Greg Tiao (clinical) [Ep 5 · 10:27](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=627)
- "The PHITT study has been ongoing for three years" — Greg Tiao (clinical) [Ep 5 · 10:27](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=627)
- "Hepatoblastoma is the most common pediatric liver cancer" — Andrew Fleming (epidemiological) [Ep 8 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=0)
- "The number of contiguous hepatic sections uninvolved by tumor can be used radiographically to determine the pre-treatment extent of disease, making the PRETEXT group" — Andrew Fleming (clinical) [Ep 8 · 0:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=30)
- "PRETEXT group in combination with presence/absence of metastatic disease, alpha fetoprotein at diagnosis, PRETEXT modifiers, patient age and resectability at diagnosis can be used to risk stratify patients according to the AHEAD 1531 clinical trial" — Andrew Fleming (guideline) [Ep 8 · 1:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=60)
- "Complete surgical resection has been determined to be necessary for patient survival" — Andrew Fleming (clinical) [Ep 8 · 1:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=90)
- "Cisplatin based chemotherapies have improved rates of resectability and subsequently survival for hepatoblastoma patients" — Andrew Fleming (clinical) [Ep 8 · 1:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=105)
- "The reported survival benefits of pulmonary metastasectomy for hepatoblastoma have varied in the literature" — Andrew Fleming (epidemiological) [Ep 8 · 2:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=120)
- "No evidence of disease is defined as a normal AFP and the absence of detectable radiographic disease on interval surveillance imaging" — Andrew Fleming (clinical) [Ep 8 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=180)
- "Among 50 patients included for analysis, 24 were determined to be high risk" — Andrew Fleming (epidemiological) [Ep 8 · 4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=240)
- "All patients received chemotherapy and 41 patients were successfully able to be rendered no evidence of disease status" — Andrew Fleming (clinical) [Ep 8 · 4:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=255)
- "14 patients underwent a total of 31 pulmonary procedures, having a median of four nodules resected per patient" — Andrew Fleming (clinical) [Ep 8 · 4:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=270)
- "Median of three nodules per patient contained pathologically confirmed viable hepatoblastoma, confirming a high degree of concordance between radiographic evidence of disease and pathological confirmation of disease" — Andrew Fleming (clinical) [Ep 8 · 5:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=300)
- "On logistic regression for three-year mortality, only achieving no evidence of disease was associated with a significant decrease in patient mortality" — Andrew Fleming (clinical) [Ep 8 · 5:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=330)
- "The overall survival of the entire cohort is quite high" — Andrew Fleming (clinical) [Ep 8 · 6:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=360)
- "The event-free survival is lower than overall survival due to relapse events after achieving no evidence of disease" — Andrew Fleming (clinical) [Ep 8 · 6:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=375)
- "The overall survival and event-free survival of the group in whom we were unable to render them no evidence of disease is significantly lower, with no patients in these cohorts surviving past two years" — Andrew Fleming (clinical) [Ep 8 · 6:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=390)
- "The overall survival is similar between high risk and not high risk patients who were able to be rendered no evidence of disease status" — Andrew Fleming (clinical) [Ep 8 · 7:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=420)
- "The event-free survival remains significantly lower for the high-risk no evidence of disease group due to five high-risk patients who relapsed" — Andrew Fleming (clinical) [Ep 8 · 7:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=435)
- "Three of five high-risk patients who relapsed were successfully salvaged using a combination of chemotherapy and further pulmonary resections" — Andrew Fleming (clinical) [Ep 8 · 7:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=450)
- "No evidence of disease status is necessary for survival in patients with hepatoblastoma" — Andrew Fleming (clinical) [Ep 8 · 7:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=465)
- "Repeated pulmonary metastasectomy and/or complex local control strategies to obtain no evidence of disease benefit high risk patients" — Andrew Fleming (clinical) [Ep 8 · 7:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=465)
- "The study was a retrospective observational study conducted at Cincinnati Children's Hospital from 2005 to 2021" — Cecilia Gigena (clinical) [Ep 9 · 0:00](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=0)
- "The study aim was to examine the effect of aggressive pursuit of no evidence of disease status on overall survival and event free status" — Cecilia Gigena (clinical) [Ep 9 · 0:20](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=20)
- "The study included 50 patients with hepatoblastoma" — Cecilia Gigena (epidemiological) [Ep 9 · 0:35](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=35)
- "41 patients were rendered to no evidence of disease status" — Cecilia Gigena (clinical) [Ep 9 · 0:42](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=42)
- "Overall survival and event free status were significantly improved in both high risk and non-high risk patients who achieved no evidence of disease status" — Cecilia Gigena (clinical) [Ep 9 · 0:48](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=48)
- "Pursuing no evidence of disease status is better for overall survival in hepatoblastoma patients" — Cecilia Gigena (opinion) [Ep 9 · 0:58](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=58)
- "Hepatoblastoma is the most common malignant liver tumor in the pediatric population" (epidemiological) [Ep 4 · 0:00](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=0)
- "There are around 250 new cases of hepatoblastoma per year" — Greg Tiao (epidemiological) [Ep 4 · 0:15](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=15)
- "Treatment algorithms for hepatoblastoma have changed dramatically over the last 20-25 years" — Greg Tiao (clinical) [Ep 4 · 0:15](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=15)
- "Neuroblastoma is considered by most to be the most common abdominal wall malignancy in children" — Greg Tiao (epidemiological) [Ep 4 · 0:51](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=51)
- "Neuroblastoma is the most common solid malignancy in the pediatric population" (epidemiological) [Ep 4 · 1:13](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=73)
- "The differential diagnosis for liver tumors includes hepatoblastoma, hemangioma, hematomas, focal nodular hyperplasia, and hepatocellular carcinoma" (clinical) [Ep 4 · 1:28](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=88)
- "Hemangioma is the most common liver lesion in children" — Greg Tiao (epidemiological) [Ep 4 · 1:41](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=101)
- "Hepatoblastoma can present as an asymptomatic abdominal mass, tumor rupture, respiratory distress due to tumor size, or as a paraneoplastic syndrome like precocious puberty" (clinical) [Ep 4 · 2:08](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=128)
- "An elevated alpha-fetoprotein (AFP) is a key component in the workup of hepatoblastoma" (clinical) [Ep 4 · 2:08](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=128)
- "AFP is critical for the diagnostic algorithm and is a guide for treatment response" (clinical) [Ep 4 · 2:08](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=128)
- "MRI is used by most experts to delineate anatomy and evaluate the extent of liver involvement in hepatoblastoma" (clinical) [Ep 4 · 2:39](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=159)
- "EOVIST is an MRI contrast agent that is taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging" — Greg Tiao (clinical) [Ep 4 · 3:00](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=180)
- "To establish a diagnosis of hepatoblastoma, four things are needed: history, abdominal imaging, AFP check, and liver biopsy" (clinical) [Ep 4 · 3:17](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=197)
- "The most important intervention for survival in hepatoblastoma is to achieve complete resection" (clinical) [Ep 4 · 3:17](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=197)
- "Aggressive resections for hepatoblastoma include trisectionectomy, mesohepatectomy, resection with an additional procedure in the remnant liver, and liver transplantation" (clinical) [Ep 4 · 3:17](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=197)
- "Couinaud labeled liver segments in a counterclockwise fashion after the districts of Paris by injecting portal vessels" — Greg Tiao (clinical) [Ep 4 · 4:08](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=248)
- "The right hepatic vein differentiates anterior sections (5 and 8) from posterior sections (6 and 7) of the right liver" — Greg Tiao (clinical) [Ep 4 · 4:45](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=285)
- "The right portal vein separates superior segments (7 and 8) from inferior segments (5 and 6) of the right liver" — Greg Tiao (clinical) [Ep 4 · 5:20](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=320)
- "The PRETEXT staging system classifies tumors based on the number of contiguous liver sections free of disease, calculated as 4 minus the number of free sections" (clinical) [Ep 4 · 5:53](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=353)
- "PRETEXT 1 has 3 contiguous sections free of disease, PRETEXT 2 has 2 contiguous sections free, PRETEXT 3 has 1 free section, and PRETEXT 4 has no free sections or diffuse tumor burden" (clinical) [Ep 4 · 6:34](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=394)
- "PRETEXT 1 and 2 tumors with greater than a centimeter margin from the middle hepatic vein and portal bifurcation should be considered for resection at diagnosis" (clinical) [Ep 4 · 6:34](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=394)
- "The change in practice for PRETEXT 3 and 4 tumors improved survival rates for hepatoblastoma from less than 30% in the 1970s and 1980s to between 80 and 90% today" — Greg Tiao (epidemiological) [Ep 4 · 7:15](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=435)
- "PRETEXT 3 tumors are generally biopsied at diagnosis and then started on neoadjuvant chemotherapy" — Greg Tiao (clinical) [Ep 4 · 7:31](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=451)
- "Indications for liver transplantation in hepatoblastoma include unresectable disease, unsafe to resect, or resection would leave inadequate liver remnant" — Greg Tiao (clinical) [Ep 4 · 7:31](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=451)
- "It is important to consult a transplant center early for PRETEXT 3 or 4 liver disease" (clinical) [Ep 4 · 8:11](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=491)
- "Teams are now trained to recognize tumors and send them to centers that offer transplant or can do aggressive resection" — Greg Tiao (clinical) [Ep 4 · 8:19](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=499)
- "The Pediatric Hepatic International Tumor Trial (FIT) is an ongoing multinational trial aimed at better delineating treatment algorithms and identifying high and low risk features for each PRETEXT stage" (clinical) [Ep 4 · 8:46](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=526)
- "The FIT study has been ongoing for three years" — Greg Tiao (clinical) [Ep 4 · 9:06](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=546)

## Changelog
- Aug 31: 20 doctors auto-found from episode dossiers
- Aug 30: 20 doctors auto-found from episode dossiers
- Aug 30: 19 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 23 doctors auto-found from episode dossiers
- Aug 29: 20 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 22 items, 14 dossiers, summaries for 2 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 15 items, 14 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 15 items, 14 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 15 items, 14 dossiers, summaries for 1 audience(s)

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