{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:05:41Z","timestamp":1790381141043,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The management of hepatoblastoma (HB) relies on chemotherapy combined with surgery, either liver resection (LR) or liver transplantation (LT), with reported overall survival (OS) of 80%, cardiac toxicity of 6%, nephrotoxicity of 21%, ototoxicity of 32%\u201346%. In clinical practice, deviations from protocol\u2010defined chemotherapy are often required to achieve resectability or bridge to transplantation. We aimed to evaluate the impact of treatment adaptation to surgical timing on OS and toxicity in a selected group of patients referred to a transplantation center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed patients with HB treated according to SIOPEL protocols at our center between 2004 and 2022. We collected clinical data, focusing on deviations from protocol\u2010specified therapy, timing of medical and surgical treatment, OS, treatment\u2010related toxicities (left ventricular ejection fraction, LVEF&lt;\u200950%, estimated glomerular filtration rate, eGFR&lt;\u200990\u2009mL\/mL\/m\n                      <jats:sup>2<\/jats:sup>\n                      , increased hearing threshold of 20\u201340\u2009dB at 4\u2009kHz).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty\u2010two patients, median age at diagnosis 1.9\u2009years (IQR 0.7\u20133.5), 16\/42 (38.1%) with metastatic disease, 24\/42 (57.1%) with vascular involvement were recorded. Additional chemotherapy beyond protocol indications, due to persistent pulmonary metastases, delayed organ availability, or disease progression was administered to 17\/20 (85%) who underwent first\u2010line LT and 10\/22 (45%) who underwent LR (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007). Death occurred in 3\/20 (15%) versus 7\/22 (31.8%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.2) respectively. After median follow\u2010up of 4.5\u2009years (IQR 1.2\u20136.2) OS is 32\/42 (71.4%); cardiotoxicity developed in 1\/42 (2.4%), nephrotoxicity in 8\/42 (19%), ototoxicity in 9\/42 (21.4%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A large proportion of patients with HB require adaptation of protocol\u2010specified therapy, especially LT candidates. This favors successful management and is not associated with increased toxicity compared to previous reports.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70447","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T11:03:30Z","timestamp":1787828610000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment Adaptation to Surgical Timing in Pediatric Hepatoblastoma: A 19\u2010Year Single\u2010Center Experience With Resection and Liver Transplantation"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6585-6213","authenticated-orcid":false,"given":"Claudia","family":"Pellegrinelli","sequence":"first","affiliation":[{"name":"Pediatric Oncology Papa Giovanni XXIII Hospital  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4239-3231","authenticated-orcid":false,"given":"Laura","family":"Cavalleri","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Papa Giovanni XXIII Hospital  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9727-5654","authenticated-orcid":false,"given":"Michela","family":"Bravi","sequence":"additional","affiliation":[{"name":"Pediatric Hepatology Gastroenterology and Transplantation Papa Giovanni XXIII Hospital  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4935-8110","authenticated-orcid":false,"given":"Paolo","family":"Marra","sequence":"additional","affiliation":[{"name":"Department of Radiology Papa Giovanni XXIII Hospital  Bergamo Italy"},{"name":"Department of Medicine and Surgery University of Milano\u2010Bicocca  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2478-8878","authenticated-orcid":false,"given":"Clarissa","family":"Valle","sequence":"additional","affiliation":[{"name":"Department of Radiology Papa Giovanni XXIII Hospital  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6837-6485","authenticated-orcid":false,"given":"Lisa","family":"Licini","sequence":"additional","affiliation":[{"name":"Unit of Pathology, Department of Oncology and Hematology Papa Giovanni XXIII Hospital  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3564-9953","authenticated-orcid":false,"given":"Domenico","family":"Pinelli","sequence":"additional","affiliation":[{"name":"Unit of General Surgery 3 and Transplantation Papa Giovanni XXIII Hospital  Bergamo 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