# Hepatocellular Carcinoma — GCMD Library living collection

Everything in the library about hepatocellular carcinoma — built automatically from dossiers that name it.

Updated: n/a · 4 episodes · 100 cited statements

## Episodes
### Surgical Management
- [Update Course 2023 - Updates in the use of ICG](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267) — video · 19:57 · [machine version](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267.md)

### Case-Based Learning
- [Clinical & Research Update: Pediatric Liver Tumors -  A Case-Based Discussion with Drs. Katherine Somers & Alex Bondoc](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848) — video · 1:09:23 · [machine version](https://team.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://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648) — video · 24:43 · [machine version](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648.md)

### Emerging & Future Directions
- [Update Course Rewind: Updates in Indocyanine Green (ICG) 2023](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000) — video · [machine version](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000.md)

## Chapters
- [0:00](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=0) PRETEXT and POSTTEXT staging systems for hepatoblastoma (Ep 1)
- [4:24](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=264) Management of PRETEXT II tumors and role of neoadjuvant chemotherapy (Ep 1)
- [11:31](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=691) Transplant versus extended resection: timing and outcomes (Ep 1)
- [14:59](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=899) Referral criteria and role of transplant centers in complex hepatoblastoma (Ep 1)
- [21:00](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1260) Biopsy approach in atypical presentations (Ep 1)
- [22:01](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1321) Management of pulmonary metastases and future research directions (Ep 1)
- [0:03](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=3) ICG for Sentinel Lymph Node Biopsy in Pediatric Sarcomas (Ep 2)
- [5:51](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=351) Technical Considerations and Laparoscopic Applications (Ep 2)
- [9:41](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=581) ICG Biology and FDA Status (Ep 2)
- [11:41](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=701) Hepatic Metastasis Detection Using Preoperative ICG (Ep 2)
- [15:15](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=915) Infrared Ureteral Stents and Future Fluorophores (Ep 2)
- [17:35](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=1055) Emerging Applications and Institutional Experience (Ep 2)
- [0:00](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=0) Introduction to ICG and Sentinel Node Case Presentation (Ep 3)
- [1:31](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=91) ICG for Sentinel Node Identification (Ep 3)
- [3:20](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=200) ICG for Hepatocellular Carcinoma Lung Metastases (Ep 3)
- [4:46](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=286) Fluorescent Ureteral Stents and Summary (Ep 3)
- [3:48](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=228) Case 1 Presentation: 2-Year-Old with Metastatic Hepatoblastoma (Ep 4)
- [11:40](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=700) Atypical Presentations and Induction Chemotherapy for Case 1 (Ep 4)
- [20:06](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1206) Surgical Planning and Technique for Case 1 (Ep 4)
- [27:57](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1677) Pathology and Adjuvant Therapy for Case 1 (Ep 4)
- [36:32](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2192) Case 2 Presentation: 9-Month-Old with Multifocal Disease and Renal Failure (Ep 4)
- [47:49](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2869) Management of Hepatoblastoma in End-Stage Renal Disease (Ep 4)
- [52:00](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3120) Combined Liver-Kidney Transplant Strategy (Ep 4)
- [61:41](https://team.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 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- PRETEXT staging stands for pre-treatment extent of disease and is based on segmental liver anatomy, performed prior to chemotherapy. (guideline) [Ep 1 · 2:02](https://team.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 difficult to assess true vascular invasion versus mass effect. (clinical) [Ep 1 · 2:28](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=148)
- POSTTEXT staging refers to extent of disease after neoadjuvant chemotherapy has been given. (guideline) [Ep 1 · 2:51](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=171)
- Key staging annotations include involvement of the retrohepatic cava or hepatic veins, and the portal vein bifurcation. (guideline) [Ep 1 · 4:10](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=250)
- COG recommendations state that PRETEXT I-II tumors with clear 1 cm margins and no vascular involvement can be resected locally without referral to specialized centers. (guideline) [Ep 1 · 7:41](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=461)
- Most tumor volume shrinkage from chemotherapy occurs within the first two cycles. (clinical) [Ep 1 · 10:14](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=614)
- After 2 cycles of chemotherapy, if the tumor has not shrunk to a resectable size, the patient should be evaluated for transplant. (guideline) [Ep 1 · 10:33](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=633)
- As hepatoblastoma tumors shrink with chemotherapy, they do not shrink away from vascular supply significantly; size decreases but vascular margins do not substantially improve. (clinical) [Ep 1 · 11:06](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=666)
- Survival after 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://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=730)
- There has been a move away from heroic resections in hepatoblastoma due to inferior survival compared to transplantation. (opinion) [Ep 1 · 12:40](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=760)
- Patients who undergo rescue transplant after failed resection do far worse than patients who have a planned transplant upfront. (clinical) [Ep 1 · 14:09](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=849)
- Current thinking is to refer patients to a transplant center early, even if two cycles of chemotherapy will be given first, to have pre-transplant evaluation completed and the patient integrated into the system. (guideline) [Ep 1 · 14:36](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=876)
- Primary transplant patients do surprisingly well despite immunosuppression for cancer, particularly in liver tumors. (clinical) [Ep 1 · 15:11](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=911)
- In the UK, all biliary atresia patients are referred upfront to a transplant center. (clinical) [Ep 1 · 16:02](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=962)
- For non-transplant center surgeons performing hepatoblastoma resection, there must be 95% confidence of successful resection with adequate margins before proceeding; otherwise referral to a transplant center is indicated. (opinion) [Ep 1 · 17:36](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1056)
- Anatomic resection with a good margin is appropriate for local management; disease near hepatic veins, crossing the liver, or involving the portal vein should be referred. (opinion) [Ep 1 · 18:11](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1091)
- Liver transplant surgeons have extensive experience operating on the liver, which may benefit pediatric surgeons managing borderline-resectable hepatoblastoma cases. (opinion) [Ep 1 · 18:55](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1135)
- Despite advanced imaging, the truth about resectability is determined at the time of operation. (clinical) [Ep 1 · 19:43](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1183)
- In Europe, all liver tumors receive chemotherapy upfront before surgery to make the tumor smaller and potentially avoid transplantation. (clinical) [Ep 1 · 19:58](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1198)
- Trisegmentectomy for cure is a reasonable approach to avoid lifelong immunosuppression from transplantation. (opinion) [Ep 1 · 20:19](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1219)
- Central hepatectomies have been performed successfully for hepatoblastoma cure without requiring transplant, though it is a difficult operation. (clinical) [Ep 1 · 20:34](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1234)
- For core needle biopsy of hepatoblastoma, approximately 10 passes are recommended, going through an area that includes normal parenchyma and tumor. (guideline) [Ep 1 · 21:25](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1285)
- There are two camps regarding pulmonary metastases in hepatoblastoma: 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 1 · 22:11](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1331)
- There is no good data on either side of the pulmonary metastases timing debate; all evidence is limited to a handful of patients. (clinical) [Ep 1 · 22:45](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1365)
- Papers examining stage 4 hepatoblastoma with pulmonary metastases are limited to cohorts of less than 20 patients, making it difficult to draw good conclusions. (epidemiological) [Ep 1 · 23:22](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1402)
- There may be reporting bias in hepatoblastoma transplant literature: successful cases (good chemo response, transplant, long-term survival) are reported, but failures may not be. (opinion) [Ep 1 · 23:38](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1418)
- PLUTO (Pediatric Liver Unresectable Tumor Observatory) is an international group seeking to answer questions about unresectable hepatoblastoma that cannot be answered at individual or multi-center level within North America or Europe. (clinical) [Ep 1 · 24:02](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1442)
- It will likely take several years before PLUTO can answer key questions about unresectable hepatoblastoma management. (opinion) [Ep 1 · 24:30](https://team.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1470)
- Rib fractures or vertebral fractures are fairly common as a presentation factor with hepatic tumors in young children, particularly hepatoblastoma. — Katherine Somers (clinical) [Ep 4 · 14:51](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=891)
- Fractures in hepatoblastoma patients will heal as they go through their therapy, and kids tend to be rather unbothered by their fractures once cancer therapy is underway. — Katherine Somers (clinical) [Ep 4 · 15:29](https://team.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 4 · 15:43](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=943)
- Weight loss or sarcopenia during active cancer therapy is associated with poor outcomes across all pediatric cancer diagnoses. — Katherine Somers (epidemiological) [Ep 4 · 19:39](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1179)
- Advanced nutritional support is a key part of care for pediatric liver tumor patients to ready them for surgical interventions. — Katherine Somers (clinical) [Ep 4 · 19:52](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1192)
- With a young child, pulmonary metastasis, and a large liver mass, hepatoblastoma is the diagnosis 99.9% of the time. — Alex Tobin (clinical) [Ep 4 · 22:03](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1323)
- There is data in pediatrics about the approach of a tumor board as it pertains to the success and long-term outcomes of patients whose cases are presented at a tumor board style multidisciplinary conference. — Alex Bondoc (epidemiological) [Ep 4 · 23:04](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1384)
- You get the maximal effect of tumor shrinkage after the first block or cycle of chemotherapy in intermediate risk patients; you typically won't get as much shrinkage after subsequent blocks. — Alex Bondoc (clinical) [Ep 4 · 24:34](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1474)
- Indocyanine green (ICG) is highly sensitive but not specific for tumor detection; it can help find multifocal disease. — Alex Bondoc (clinical) [Ep 4 · 26:05](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1565)
- In about 15% of lung resections for hepatoblastoma metastases, ICG fluorescence finds lesions not visible on high-resolution CT imaging. — Alex Bondoc (clinical) [Ep 4 · 26:21](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1581)
- You can see tumor through vessel walls with indocyanine green. — Alex Bondoc (clinical) [Ep 4 · 26:46](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1606)
- The FIT trial (AHEP 1531) mandated liver biopsy for diagnosis before starting treatment. — Ranga (Ranganathan) (guideline) [Ep 4 · 30:05](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1805)
- Once chemotherapy begins and the tumor gets replaced by pools of blood and fibrous tissue, there's nothing for the chemotherapy to kill, and the size doesn't decrease much further beyond a certain point. — Ranga (Ranganathan) (clinical) [Ep 4 · 33:19](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1999)
- For patients with successful primary tumor resection, the first surgical goal is always primary tumor resection whenever possible. — Katherine Somers (clinical) [Ep 4 · 34:31](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2071)
- After primary tumor resection, consolidation chemotherapy alternates carboplatin-doxorubicin cycles with staged lung metastasectomy procedures. — Katherine Somers (clinical) [Ep 4 · 34:49](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2089)
- In patients with known vascular invasion and metastatic disease, continuing chemotherapy despite beautiful response helps weed out any remaining circulating cells that remain active. — Katherine Somers (clinical) [Ep 4 · 35:47](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2147)
- Hematogenous metastases to the lungs are the primary metastatic site for hepatoblastoma. — Alex Bondoc (clinical) [Ep 4 · 36:56](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2216)
- 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 4 · 38:46](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2326)
- Even when one side of the chest shows no viable tumor after chemotherapy, the other side is still cleared surgically because that is the best pathway to long-term disease control and maintenance of remission. — Katherine Somers (clinical) [Ep 4 · 39:20](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2360)
- ICG fluorescence correlates with the viability of lung metastases; non-fluorescent masses may represent dead tumor. — Alex Bondoc (clinical) [Ep 4 · 40:42](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2442)
- Patients with hepatoblastoma are frequently born prematurely. — Alex Tobin (epidemiological) [Ep 4 · 45:00](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2700)
- Known risk factors for developing hepatoblastoma include Beckwith-Wiedemann syndrome, hemihypertrophy syndromes, trisomy 18, autosomal recessive polycystic kidney disease, and extreme prematurity. — Katherine Somers (epidemiological) [Ep 4 · 48:44](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2924)
- It's not just autosomal recessive polycystic kidney disease children who develop hepatoblastoma; there is increased incidence in end-stage renal disease early in life. — Katherine Somers (epidemiological) [Ep 4 · 49:18](https://team.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 it can cause chronic kidney disease. — Katherine Somers (clinical) [Ep 4 · 49:39](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2979)
- Platinum-based chemotherapy can be delivered to patients on peritoneal dialysis using advanced pharmacokinetic and pharmacodynamic modeling systems without typical mandated hyperhydration. — Katherine Somers (clinical) [Ep 4 · 50:02](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3002)
- Hepatoblastoma typically presents in the toddler range (first and second year of life), but predisposed patients can develop it as early as congenital or immediately post-delivery. — Katherine Somers (clinical) [Ep 4 · 50:59](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3059)
- For known predisposition patients, screening protocol includes ultrasound and alpha-fetoprotein levels, taking into account that AFP has a very different range of normal values in the first months of life. — Katherine Somers (clinical) [Ep 4 · 51:20](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3080)
- PRETEXT 4 multifocal disease mandates liver transplant as the surgical approach. — Alex Bondoc (clinical) [Ep 4 · 52:15](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3135)
- In deceased donor liver transplant for hepatoblastoma, you cannot have extrahepatic disease because of the huge induction of immunosuppression required. — Alex Bondoc (clinical) [Ep 4 · 58:50](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3530)
- In the United States, a child with hepatoblastoma automatically gets status 1B categorization on the deceased donor list, which is the second highest stratum for organ allocation. — Alex Bondoc (guideline) [Ep 4 · 59:46](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3586)
- A patient with hepatoblastoma typically does not have underlying liver disease, unlike most liver transplant candidates. — Alex Bondoc (clinical) [Ep 4 · 60:10](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3610)
- Vincristine-irinotecan is a less intensive regimen that can be used as maintenance therapy while waiting for organ offers during transplant listing. — Katherine Somers (clinical) [Ep 4 · 60:58](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3658)
- Conventional hepatoblastoma is genomically quiet with very low mutation burden and invariably has either a point mutation or small deletion in exon 3 of the CTNNB1 gene. — Ranga (Ranganathan) (clinical) [Ep 4 · 62:23](https://team.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 with large deletions or complete exon 3 skipping (exon 2 joined to exon 4). — Ranga (Ranganathan) (clinical) [Ep 4 · 62:41](https://team.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 very weak positive or even negative in hepatocellular neoplasm NOS, which is a clue to diagnosis along with pleomorphic appearance and macrotrabecular arrangement. — Ranga (Ranganathan) (clinical) [Ep 4 · 63:19](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3799)
- Hepatocellular neoplasm 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 4 · 63:51](https://team.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 a new cancer diagnosis meets with oncology genetic counseling team for complete genetic testing including germline testing if something is identified. — Katherine Somers (clinical) [Ep 4 · 64:50](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3890)
- Radiomics can predict pure fetal histology hepatoblastoma with area under the receiver operating curve of about 0.85. — Alex Tobin (clinical) [Ep 4 · 66:36](https://team.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 4 · 66:58](https://team.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 hepatoblastoma tumors very accurately at the level of an expert. — Alex Tobin (clinical) [Ep 4 · 67:13](https://team.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=4033)
- ICG can be used as an adjunct to sentinel node identification in pediatric surgical oncology — Seth Goldstein (clinical) [Ep 2 · 3:16](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=196)
- Sentinel node biopsy in pediatric rhabdomyosarcoma is standard of care and dictates drug regimen and indicates radiation to lymph node basin if positive — Seth Goldstein (guideline) [Ep 2 · 1:36](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=96)
- ICG technique allows real-time intraoperative control of injection location (intratumoral vs. four quadrants, dermal vs. subdermal) by surgeons rather than radiologists — Seth Goldstein (clinical) [Ep 2 · 4:00](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=240)
- ICG fluorescence visualization occurs over 45-75 seconds after injection, allowing direct observation of lymphatic drainage to sentinel node — Seth Goldstein (clinical) [Ep 2 · 5:20](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=320)
- Near-infrared fluorescence penetrates approximately 1-2 centimeters through soft tissue — Tom Isch (clinical) [Ep 2 · 7:23](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=443)
- ICG enables laparoscopic sentinel node identification in paratesticular rhabdomyosarcoma, which is not feasible with radiotracer methods — Seth Goldstein (clinical) [Ep 2 · 8:40](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=520)
- In children under 10 years old with paratesticular rhabdomyosarcoma, sentinel node biopsy may be performed instead of full ipsilateral lymph node clearance — Seth Goldstein (guideline) [Ep 2 · 8:40](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=520)
- Indocyanine green was developed by Kodak company after World War II and has been FDA approved since the 1960s — Seth Goldstein (clinical) [Ep 2 · 9:47](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=587)
- ICG is approved for all adult and pediatric applications with no on-label or off-label concerns — Seth Goldstein (guideline) [Ep 2 · 10:30](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=630)
- ICG is exclusively cleared through the biliary system — Seth Goldstein (clinical) [Ep 2 · 11:41](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=701)
- For hepatic metastases in the chest, ICG administered 24 hours preoperatively will be retained only in liver tissue by the time of thoracotomy, enabling metastasis localization — Seth Goldstein (clinical) [Ep 2 · 12:00](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=720)
- ICG technique for hepatic metastases is successful for hepatoblastoma but has not been successful for Wilms tumor — Tom Isch (clinical) [Ep 2 · 12:32](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=752)
- Sarcomas other than hepatic primaries require much higher ICG dosage and are less specific — Seth Goldstein (clinical) [Ep 2 · 12:39](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=759)
- Wilms tumor metastases in the lungs are avid for ICG, though the primary kidney tumor is not — Seth Goldstein (clinical) [Ep 2 · 13:34](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=814)
- ICG fluorescence identifies additional pulmonary metastases beyond what visual inspection and palpation detect during thoracotomy — Seth Goldstein (clinical) [Ep 2 · 14:00](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=840)
- Infrared ureteral stents emit light that travels through centimeters of tissue and can be detected by standard fluorescence imaging systems — Seth Goldstein (clinical) [Ep 2 · 16:20](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=980)
- A renally-cleared fluorophore is under investigation that could enable ureteral identification without stent placement — Seth Goldstein (clinical) [Ep 2 · 17:00](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=1020)
- ICG can identify accessory cystic ducts during cholecystectomy by showing separate fluorescence of the accessory duct, main cystic duct, and common bile duct — Tom Isch (clinical) [Ep 2 · 19:00](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=1140)
- ICG is used for vascular mapping in partial nephrectomy for Wilms tumor — Tom Isch (clinical) [Ep 2 · 18:45](https://team.globalcastmd.com/watch/update-course-2023-updates-in-the-use-of-icg-7267?t=1125)
- Indocyanine Green was discovered by the post-World War II Kodak company and has been FDA approved since the 1960s. — Seth Goldstein (clinical) [Ep 3 · 0:39](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=39)
- ICG is a safe, harmless fluorescent contrast that can be injected subcutaneously or intravenously depending on the use. — Seth Goldstein (clinical) [Ep 3 · 0:39](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=39)
- ICG usage has really developed in hepatobiliary surgery. — Seth Goldstein (clinical) [Ep 3 · 0:39](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=39)
- Sentinel node biopsy at the time of port placement for alveolar rhabdomyosarcoma is pretty much standard of care. — Seth Goldstein (guideline) [Ep 3 · 0:39](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=39)
- Pediatric surgeons can consider use of ICG as an adjunct to sentinel node identification. — Seth Goldstein (opinion) [Ep 3 · 2:12](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=132)
- ICG can be used in the operating room with equipment that is either already present or about to be standard in all laparoscopic towers. — Seth Goldstein (clinical) [Ep 3 · 2:12](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=132)
- After indocyanine injection into the tumor, ICG travels to the sentinel node over the course of 45, 60, or 75 seconds. — Seth Goldstein (clinical) [Ep 3 · 2:12](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=132)
- ICG is exclusively biliary cleared. — Seth Goldstein (clinical) [Ep 3 · 4:00](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=240)
- For detecting liver tissue metastases in the chest, ICG should be given the day before surgery so it is the only thing left in the chest by the time of thoracotomy. — Seth Goldstein (clinical) [Ep 3 · 4:00](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=240)
- At the time of thoracotomies for lung metastases, if ICG is given the day before, additional metastases can be found beyond what is detected by palpation and visual inspection. — Seth Goldstein (clinical) [Ep 3 · 4:00](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=240)
- Spots detected by ICG in the chest after preoperative administration are also positive on histology. — Seth Goldstein (clinical) [Ep 3 · 4:00](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=240)
- Fluorescent ureteral stents that emit infrared light can be detected by standard laparoscopic systems and help protect ureters during pelvic tumor resection. — Seth Goldstein (clinical) [Ep 3 · 4:46](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=286)
- Fluorescent ureteral stents can enable minimally invasive approaches to cases that would otherwise require open surgery due to ureteral proximity to tumor. — Seth Goldstein (opinion) [Ep 3 · 4:46](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=286)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Technetium-99 radio tracer is normally used for sentinel node location and can be detected with a special detector. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 3 · 1:31](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=91)
- Using radio tracer requires coordination between oncologists and surgeons to purchase machines and coordinate tracer injection with same-day operations. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 3 · 1:31](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=91)
- Most new laparoscopic towers have an integrated system with a specific mode that can detect ICG. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 3 · 2:53](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=173)
- ICG is being used as the primary localizer of the sentinel node while still confirming with Technetium. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 3 · 2:53](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=173)
- For liver transplant due to hepatic carcinomas, zero metastasis is required, which often necessitates bilateral lung metastasectomies. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 3 · 3:20](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=200)
- ICG is excreted by the biliary tract. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 3 · 5:38](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=338)
- ICG can be used to detect sentinel nodes in many types of cancer using either laparoscopic or open instruments. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 3 · 5:38](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=338)
- Given 24 hours in advance, ICG can be useful to detect hepatocarcinoma lung metastasis because it is primarily excreted through hepatic cells. — Cecilia Gigena summarizes what Dr. Seth Goldstein said [Ep 3 · 5:38](https://team.globalcastmd.com/watch/update-course-rewind-updates-in-indocyanine-green-2023-8000?t=338)

## Changelog
- Sep 25: 1 item added automatically
- Sep 21: 3 items added automatically

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