Excellent Outcome of Residual Pulmonary Metastases in Initially High Burden Metastatic Hepatoblastoma: A Case Series

BACKGROUND: SIOPEL-4 protocol has improved survival for metastatic hepatoblastoma. Intensified adjuvant chemotherapy is given to those with persistent pulmonary nodules post primary tumour resection. Multiple (≥10), bilateral pulmonary metastases at diagnosis, and cumulative nodule size have been linked to poorer prognosis. Reports suggest intensifying upfront treatment for these patients compared with those with lower initial metastatic burden. OBSERVATIONS: We report 3 cases with ≥20 bilateral, large, pulmonary metastases at diagnosis and persistent lesions postadjuvant chemotherapy. Despite high-risk features, all achieved long-term remission. CONCLUSIONS: Risk prediction may be better assessed by markers of treatment response than by initial metastatic load.