Hepatoblastoma brain metastasis treated with stereotactic radiosurgery: Illustrative case and literature search

Hepatoblastoma (HB) is the most prevalent pediatric liver malignancy, typically affecting children under 5 years of age. Although advances in multimodal therapy, including surgical resection and chemotherapy, have significantly improved survival rates, distant metastases, particularly to the lungs and the brain, remain a critical prognostic challenge. Brain metastases (BMs) from HB are exceedingly rare, with only a limited number of cases reported in the literature, and the management of these lesions is challenging. Stereotactic radiosurgery (SRS) is an increasingly popular treatment option for BM due to its ability to deliver high doses of radiation to the target volume with minimal exposure to surrounding normal tissues. In this paper, we present a rare case of HB with brain metastasis that was treated with SRS for the 1^st time.

The case was a 4-year-old male with a history of stage IV HB who was diagnosed with a single BM. Post-treatment magnetic resonance images following SRS revealed a reduction in lesion size on 6^th-month follow-up imaging and then a stable lesion on further follow-up imaging. The case highlights the potential efficacy of SRS as a treatment option for BM from HB and supports its usage in the management of this complex condition. The progression-free survival was 17 months, and the overall survival was 84 months.

SRS may represent a safe and effective treatment modality for HB BM, particularly in patients who are not suitable candidates for surgical resection or systemic therapy. Larger studies with extended follow-up are necessary to more accurately assess the long-term safety, efficacy, and clinical utility of SRS in the management of HB-related BM.