2017 PRETEXT: radiologic staging system for primary hepatic malignancies of childhood revised for the Paediatric Hepatic International Tumour Trial (PHITT)

Abstract

Imaging is crucial in the assessment of children with a primary hepatic malignancy. Since its inception in 1992, the PRETEXT (PRE-Treatment EXTent of tumor) system has become the primary method of risk stratification for hepatoblastoma and pediatric hepatocellular carcinoma in numerous cooperative group trials across the world. The PRETEXT system is made of two components: the PRETEXT group and the annotation factors. The PRETEXT group describes the extent of tumor within the liver while the annotation factors help to describe associated features such as vascular involvement (either portal vein or hepatic vein/inferior vena cava), extrahepatic disease, multifocality, tumor rupture and metastatic disease (to both the lungs and lymph nodes). This manuscript is written by members of the Children's Oncology Group (COG) in North America, the International Childhood Liver Tumors Strategy Group (SIOPEL) in Europe, and the Japanese Study Group for Pediatric Liver Tumor (JPLT; now part of the Japan Children's Cancer Group) and represents an international consensus update to the 2005 PRETEXT definitions. These definitions will be used in the forthcoming Trial to Pediatric Hepatic International Tumor Trial (PHITT).

Treatment outcome and pattern of failure in hepatoblastoma treated with a consensus protocol in Hong Kong

“…Disease incidence was calculated with the population data from the Government Census . Central radiological review and retrospective assignment of PRETEXT staging, SIOPEL risk group (2005 version) and CHIC risk group (based on PRETEXT 2017 version), were performed whenever possible (film review = 26; report review = 18) . Tumor specimens when available were reviewed by an experienced liver pathologist (R.L.)…”

“…Previous European and North American strategies differed in that neoadjuvant chemotherapy was advocated in all SIOPEL protocols, whereas upfront surgery was recommended for patients with resectable tumors in the Children's Oncology Group (COG) studies. Among the various predicting factors, the Pretreatment Extent of Disease (PRETEXT) staging has emerged as the key in risk stratification for clinical trials in the past decade . Despite the ethnic preponderance, data on outcome of HB in Chinese are limited.…”

Use of a donor iliac vein graft for reconstruction of the inferior vena cava in liver transplantation for hepatoblastoma with caval extension

“…An 18‐month‐old female child was diagnosed with a PRETEXT Stage IV (P, V, F) hepatoblastoma with compression and effacement of the IVC, PV, and hepatic veins at the porta hepatis noted on MRI . The lesion was predominantly in the right lobe of the liver (11.6 cm × 8 cm × 10 cm) with a second focal lesion in segment 2 of the liver as demonstrated in Figure .…”

Pediatric hepatoblastoma and hepatocellular carcinoma: lessons learned in the last decade

“…In this issue of Pediatric Radiology, we have an excellent series of articles on imaging and image-guided interventions in pediatric hepatic malignancies [1][2][3][4]. These articles are the result of several years of collaboration among pediatric radiologists, interventional radiologists, surgeons and oncologists at their individual institutions and in international cooperative groups.…”

“…The first article in this series [1] focuses on imaging of pediatric liver malignancies and provides an update to the 2005 revision of the PRETEXT classification system [7]. Just as the Liver Imaging Reporting and Data System (LIRADS) provides consistent guidelines for evaluating adults at risk of developing hepatocellular carcinoma, this update on the PRETEXT imaging system provides concise definitions for imaging pediatric hepatic malignancies [8].…”