I think again just kind of the biggest takeaway is there is no threshold for disease burden that precludes you from aggressively trying to achieve no evidence of disease in children with hepatolastoma.
On logistic regression for three-year mortality, uh only achieving no evidence of disease was associated with a significant decrease in patient mortality.
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
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
BOB Ped Surg 2023 - Andrew Fleming, AAP - Presentation
▶Ep 8 · 0:00
epidemiologicalHepatoblastoma is the most common pediatric liver cancer↗
▶Ep 8 · 0:30
clinicalThe number of contiguous hepatic sections uninvolved by tumor can be used radiographically to determine the pre-treatment extent of disease, making the PRETEXT group↗
▶Ep 8 · 1:00
guidelinePRETEXT 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↗
▶Ep 8 · 1:30
clinicalComplete surgical resection has been determined to be necessary for patient survival↗
▶Ep 8 · 1:30
quoteComplete surgical resection has been determined uh to be necessary for patient survival.↗
▶Ep 8 · 1:45
clinicalCisplatin based chemotherapies have improved rates of resectability and subsequently survival for hepatoblastoma patients↗
▶Ep 8 · 2:00
epidemiologicalThe reported survival benefits of pulmonary metastasectomy for hepatoblastoma have varied in the literature↗
▶Ep 8 · 3:00
quoteno evidence of disease is defined as a normal AFP and the absence of detectable radiographic disease on interval surveillance imaging.↗
▶Ep 8 · 3:00
clinicalNo evidence of disease is defined as a normal AFP and the absence of detectable radiographic disease on interval surveillance imaging↗
▶Ep 8 · 4:00
epidemiologicalAmong 50 patients included for analysis, 24 were determined to be high risk↗
▶Ep 8 · 4:15
clinicalAll patients received chemotherapy and 41 patients were successfully able to be rendered no evidence of disease status↗
▶Ep 8 · 4:30
quoteOur group takes a fairly aggressive approach to pulmonary metastasectomy for these patients, including bilateral uh reoperative pulmonary resections if necessary.↗
▶Ep 8 · 4:30
clinical14 patients underwent a total of 31 pulmonary procedures, having a median of four nodules resected per patient↗
▶Ep 8 · 5:00
clinicalMedian 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↗
▶Ep 8 · 5:30
clinicalOn logistic regression for three-year mortality, only achieving no evidence of disease was associated with a significant decrease in patient mortality↗
▶Ep 8 · 5:30
quoteOn logistic regression for three-year mortality, uh only achieving no evidence of disease was associated with a significant decrease in patient mortality.↗
▶Ep 8 · 6:00
clinicalThe overall survival of the entire cohort is quite high↗
▶Ep 8 · 6:15
clinicalThe event-free survival is lower than overall survival due to relapse events after achieving no evidence of disease↗
▶Ep 8 · 6:30
clinicalThe 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↗
▶Ep 8 · 6:45
quoteno patients in these cohorts uh surviving past two years.↗
▶Ep 8 · 7:00
clinicalThe overall survival is similar between high risk and not high risk patients who were able to be rendered no evidence of disease status↗
▶Ep 8 · 7:15
clinicalThe event-free survival remains significantly lower for the high-risk no evidence of disease group due to five high-risk patients who relapsed↗
▶Ep 8 · 7:30
clinicalThree of five high-risk patients who relapsed were successfully salvaged using a combination of chemotherapy and further pulmonary resections↗
▶Ep 8 · 7:45
clinicalRepeated pulmonary metastasectomy and/or complex local control strategies to obtain no evidence of disease benefit high risk patients↗
▶Ep 8 · 7:45
clinicalNo evidence of disease status is necessary for survival in patients with hepatoblastoma↗
Journal of Pediatric Article Review: June 2023, AAP Issue
▶Ep 10 · 7:10
clinicalOnce NED status was achieved, 10-year overall survival among high-risk hepatoblastoma patients was similar to patients who were not high-risk↗
▶Ep 10 · 7:10
quoteOnce no evidence of disease status was achieved, the 10 year overall survival. Among patients that were high risk from the get-go was actually similar to patients that were not high risk, which I think again kind of emphasizes that if you are able to get children to that point, they can have long-term survival despite being stratified into a very high-risk group from the beginning.↗
▶Ep 10 · 8:06
quoteI think again, just kind of the biggest takeaway is there is no threshold for disease burden that precludes you from aggressively trying to achieve no evidence of disease uh in children with hepatblastoma.↗
▶Ep 10 · 8:06
opinionThere is no threshold for disease burden that precludes aggressive pursuit of no-evidence-of-disease status in children with hepatoblastoma↗
Andrew's statements about Liver Tumors (Hepatoblastoma/HCC)33 statements
BOB Ped Surg 2023 - Andrew Fleming, AAP - Presentation
▶Ep 8 · 0:00
epidemiologicalHepatoblastoma is the most common pediatric liver cancer↗
▶Ep 8 · 0:30
clinicalThe number of contiguous hepatic sections uninvolved by tumor can be used radiographically to determine the pre-treatment extent of disease, making the PRETEXT group↗
▶Ep 8 · 1:00
guidelinePRETEXT 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↗
▶Ep 8 · 1:30
quoteComplete surgical resection has been determined uh to be necessary for patient survival.↗
▶Ep 8 · 1:30
clinicalComplete surgical resection has been determined to be necessary for patient survival↗
▶Ep 8 · 1:45
clinicalCisplatin based chemotherapies have improved rates of resectability and subsequently survival for hepatoblastoma patients↗
▶Ep 8 · 2:00
epidemiologicalThe reported survival benefits of pulmonary metastasectomy for hepatoblastoma have varied in the literature↗
▶Ep 8 · 3:00
quoteno evidence of disease is defined as a normal AFP and the absence of detectable radiographic disease on interval surveillance imaging.↗
▶Ep 8 · 3:00
clinicalNo evidence of disease is defined as a normal AFP and the absence of detectable radiographic disease on interval surveillance imaging↗
▶Ep 8 · 4:00
epidemiologicalAmong 50 patients included for analysis, 24 were determined to be high risk↗
▶Ep 8 · 4:15
clinicalAll patients received chemotherapy and 41 patients were successfully able to be rendered no evidence of disease status↗
▶Ep 8 · 4:30
quoteOur group takes a fairly aggressive approach to pulmonary metastasectomy for these patients, including bilateral uh reoperative pulmonary resections if necessary.↗
▶Ep 8 · 4:30
clinical14 patients underwent a total of 31 pulmonary procedures, having a median of four nodules resected per patient↗
▶Ep 8 · 5:00
clinicalMedian 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↗
▶Ep 8 · 5:30
quoteOn logistic regression for three-year mortality, uh only achieving no evidence of disease was associated with a significant decrease in patient mortality.↗
▶Ep 8 · 5:30
clinicalOn logistic regression for three-year mortality, only achieving no evidence of disease was associated with a significant decrease in patient mortality↗
▶Ep 8 · 6:00
clinicalThe overall survival of the entire cohort is quite high↗
▶Ep 8 · 6:15
clinicalThe event-free survival is lower than overall survival due to relapse events after achieving no evidence of disease↗
▶Ep 8 · 6:30
clinicalThe 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↗
▶Ep 8 · 6:45
quoteno patients in these cohorts uh surviving past two years.↗
▶Ep 8 · 7:00
clinicalThe overall survival is similar between high risk and not high risk patients who were able to be rendered no evidence of disease status↗
▶Ep 8 · 7:15
clinicalThe event-free survival remains significantly lower for the high-risk no evidence of disease group due to five high-risk patients who relapsed↗
▶Ep 8 · 7:30
clinicalThree of five high-risk patients who relapsed were successfully salvaged using a combination of chemotherapy and further pulmonary resections↗
▶Ep 8 · 7:45
clinicalRepeated pulmonary metastasectomy and/or complex local control strategies to obtain no evidence of disease benefit high risk patients↗
▶Ep 8 · 7:45
clinicalNo evidence of disease status is necessary for survival in patients with hepatoblastoma↗
Journal of Pediatric Article Review: June 2023, AAP Issue
▶Ep 10 · 7:10
quoteOnce no evidence of disease status was achieved, the 10 year overall survival. Among patients that were high risk from the get-go was actually similar to patients that were not high risk, which I think again kind of emphasizes that if you are able to get children to that point, they can have long-term survival despite being stratified into a very high-risk group from the beginning.↗
▶Ep 10 · 7:10
clinicalOnce NED status was achieved, 10-year overall survival among high-risk hepatoblastoma patients was similar to patients who were not high-risk↗
▶Ep 10 · 7:10
clinicalOnce NED status was achieved, 10-year overall survival among high-risk hepatoblastoma patients was similar to patients who were not high-risk↗
▶Ep 10 · 7:10
quoteOnce no evidence of disease status was achieved, the 10 year overall survival. Among patients that were high risk from the get-go was actually similar to patients that were not high risk, which I think again kind of emphasizes that if you are able to get children to that point, they can have long-term survival despite being stratified into a very high-risk group from the beginning.↗
▶Ep 10 · 8:06
opinionThere is no threshold for disease burden that precludes aggressive pursuit of no-evidence-of-disease status in children with hepatoblastoma↗
▶Ep 10 · 8:06
opinionThere is no threshold for disease burden that precludes aggressive pursuit of no-evidence-of-disease status in children with hepatoblastoma↗
▶Ep 10 · 8:06
quoteI think again, just kind of the biggest takeaway is there is no threshold for disease burden that precludes you from aggressively trying to achieve no evidence of disease uh in children with hepatblastoma.↗
▶Ep 10 · 8:06
quoteI think again, just kind of the biggest takeaway is there is no threshold for disease burden that precludes you from aggressively trying to achieve no evidence of disease uh in children with hepatblastoma.↗
Andrew's statements about Metastatic Disease25 statements
BOB Ped Surg 2023 - Andrew Fleming, AAP - Presentation
▶Ep 3 · 0:00
epidemiologicalHepatoblastoma is the most common pediatric liver cancer↗
▶Ep 3 · 0:30
clinicalThe number of contiguous hepatic sections uninvolved by tumor can be used radiographically to determine the pre-treatment extent of disease, making the PRETEXT group↗
▶Ep 3 · 1:00
guidelinePRETEXT 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↗
▶Ep 3 · 1:30
quoteComplete surgical resection has been determined uh to be necessary for patient survival.↗
▶Ep 3 · 1:30
clinicalComplete surgical resection has been determined to be necessary for patient survival↗
▶Ep 3 · 1:45
clinicalCisplatin based chemotherapies have improved rates of resectability and subsequently survival for hepatoblastoma patients↗
▶Ep 3 · 2:00
epidemiologicalThe reported survival benefits of pulmonary metastasectomy for hepatoblastoma have varied in the literature↗
▶Ep 3 · 3:00
clinicalNo evidence of disease is defined as a normal AFP and the absence of detectable radiographic disease on interval surveillance imaging↗
▶Ep 3 · 3:00
quoteno evidence of disease is defined as a normal AFP and the absence of detectable radiographic disease on interval surveillance imaging.↗
▶Ep 3 · 4:00
epidemiologicalAmong 50 patients included for analysis, 24 were determined to be high risk↗
▶Ep 3 · 4:15
clinicalAll patients received chemotherapy and 41 patients were successfully able to be rendered no evidence of disease status↗
▶Ep 3 · 4:30
clinical14 patients underwent a total of 31 pulmonary procedures, having a median of four nodules resected per patient↗
▶Ep 3 · 4:30
quoteOur group takes a fairly aggressive approach to pulmonary metastasectomy for these patients, including bilateral uh reoperative pulmonary resections if necessary.↗
▶Ep 3 · 5:00
clinicalMedian 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↗
▶Ep 3 · 5:30
quoteOn logistic regression for three-year mortality, uh only achieving no evidence of disease was associated with a significant decrease in patient mortality.↗
▶Ep 3 · 5:30
clinicalOn logistic regression for three-year mortality, only achieving no evidence of disease was associated with a significant decrease in patient mortality↗
▶Ep 3 · 6:00
clinicalThe overall survival of the entire cohort is quite high↗
▶Ep 3 · 6:15
clinicalThe event-free survival is lower than overall survival due to relapse events after achieving no evidence of disease↗
▶Ep 3 · 6:30
clinicalThe 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↗
▶Ep 3 · 6:45
quoteno patients in these cohorts uh surviving past two years.↗
▶Ep 3 · 7:00
clinicalThe overall survival is similar between high risk and not high risk patients who were able to be rendered no evidence of disease status↗
▶Ep 3 · 7:15
clinicalThe event-free survival remains significantly lower for the high-risk no evidence of disease group due to five high-risk patients who relapsed↗
▶Ep 3 · 7:30
clinicalThree of five high-risk patients who relapsed were successfully salvaged using a combination of chemotherapy and further pulmonary resections↗
▶Ep 3 · 7:45
clinicalNo evidence of disease status is necessary for survival in patients with hepatoblastoma↗
▶Ep 3 · 7:45
clinicalRepeated pulmonary metastasectomy and/or complex local control strategies to obtain no evidence of disease benefit high risk patients↗
Andrew's statements about Pediatric Oncology33 statements
BOB Ped Surg 2023 - Andrew Fleming, AAP - Presentation
▶Ep 422 · 0:00
epidemiologicalHepatoblastoma is the most common pediatric liver cancer↗
▶Ep 422 · 0:30
clinicalThe number of contiguous hepatic sections uninvolved by tumor can be used radiographically to determine the pre-treatment extent of disease, making the PRETEXT group↗
▶Ep 422 · 1:00
guidelinePRETEXT 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↗
▶Ep 422 · 1:30
clinicalComplete surgical resection has been determined to be necessary for patient survival↗
▶Ep 422 · 1:30
quoteComplete surgical resection has been determined uh to be necessary for patient survival.↗
▶Ep 422 · 1:45
clinicalCisplatin based chemotherapies have improved rates of resectability and subsequently survival for hepatoblastoma patients↗
▶Ep 422 · 2:00
epidemiologicalThe reported survival benefits of pulmonary metastasectomy for hepatoblastoma have varied in the literature↗
▶Ep 422 · 3:00
clinicalNo evidence of disease is defined as a normal AFP and the absence of detectable radiographic disease on interval surveillance imaging↗
▶Ep 422 · 3:00
quoteno evidence of disease is defined as a normal AFP and the absence of detectable radiographic disease on interval surveillance imaging.↗
▶Ep 422 · 4:00
epidemiologicalAmong 50 patients included for analysis, 24 were determined to be high risk↗
▶Ep 422 · 4:15
clinicalAll patients received chemotherapy and 41 patients were successfully able to be rendered no evidence of disease status↗
▶Ep 422 · 4:30
clinical14 patients underwent a total of 31 pulmonary procedures, having a median of four nodules resected per patient↗
▶Ep 422 · 4:30
quoteOur group takes a fairly aggressive approach to pulmonary metastasectomy for these patients, including bilateral uh reoperative pulmonary resections if necessary.↗
▶Ep 422 · 5:00
clinicalMedian 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↗
▶Ep 422 · 5:30
clinicalOn logistic regression for three-year mortality, only achieving no evidence of disease was associated with a significant decrease in patient mortality↗
▶Ep 422 · 5:30
quoteOn logistic regression for three-year mortality, uh only achieving no evidence of disease was associated with a significant decrease in patient mortality.↗
▶Ep 422 · 6:00
clinicalThe overall survival of the entire cohort is quite high↗
▶Ep 422 · 6:15
clinicalThe event-free survival is lower than overall survival due to relapse events after achieving no evidence of disease↗
▶Ep 422 · 6:30
clinicalThe 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↗
▶Ep 422 · 6:45
quoteno patients in these cohorts uh surviving past two years.↗
▶Ep 422 · 7:00
clinicalThe overall survival is similar between high risk and not high risk patients who were able to be rendered no evidence of disease status↗
▶Ep 422 · 7:15
clinicalThe event-free survival remains significantly lower for the high-risk no evidence of disease group due to five high-risk patients who relapsed↗
▶Ep 422 · 7:30
clinicalThree of five high-risk patients who relapsed were successfully salvaged using a combination of chemotherapy and further pulmonary resections↗
▶Ep 422 · 7:45
clinicalNo evidence of disease status is necessary for survival in patients with hepatoblastoma↗
▶Ep 422 · 7:45
clinicalRepeated pulmonary metastasectomy and/or complex local control strategies to obtain no evidence of disease benefit high risk patients↗
Journal of Pediatric Article Review: June 2023, AAP Issue
▶Ep 446 · 7:10
quoteOnce no evidence of disease status was achieved, the 10 year overall survival. Among patients that were high risk from the get-go was actually similar to patients that were not high risk, which I think again kind of emphasizes that if you are able to get children to that point, they can have long-term survival despite being stratified into a very high-risk group from the beginning.↗
▶Ep 446 · 7:10
clinicalOnce NED status was achieved, 10-year overall survival among high-risk hepatoblastoma patients was similar to patients who were not high-risk↗
▶Ep 446 · 8:06
opinionThere is no threshold for disease burden that precludes aggressive pursuit of no-evidence-of-disease status in children with hepatoblastoma↗
▶Ep 446 · 8:06
quoteI think again, just kind of the biggest takeaway is there is no threshold for disease burden that precludes you from aggressively trying to achieve no evidence of disease uh in children with hepatblastoma.↗
Journal of Pediatric Surgery Article Review: June 2023, AAP Issue
▶Ep 683 · 7:10
epidemiologicalOnce no-evidence-of-disease status was achieved, the 10-year overall survival among high-risk hepatoblastoma patients was similar to patients who were not high-risk.↗
▶Ep 683 · 7:10
quoteOnce no evidence of disease status was achieved, the 10 year overall survival. Among patients that were high risk from the get-go was actually similar to patients that were not high risk, which I think again kind of emphasizes that if you are able to get children to that point, they can have long-term survival despite being stratified into a very high-risk group from the beginning.↗
▶Ep 683 · 8:06
opinionThere is no threshold for disease burden that precludes aggressive pursuit of no-evidence-of-disease status in children with hepatoblastoma.↗
▶Ep 683 · 8:06
quoteI think again just kind of the biggest takeaway is there is no threshold for disease burden that precludes you from aggressively trying to achieve no evidence of disease in children with hepatolastoma.↗
