# SIOPEL-3: cisplatin versus cisplatin plus doxorubicin for standard-risk hepatoblastoma

Source: https://onco.cc/key-papers/paper-siopel-3-cisplatin-vs-plado-standard-risk-hepatoblastoma-perilongo-nejm-2009/  
OnCo record `paper-siopel-3-cisplatin-vs-plado-standard-risk-hepatoblastoma-perilongo-nejm-2009` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Children with standard-risk hepatoblastoma were cured just as often with cisplatin alone as with cisplatin plus doxorubicin, and had far fewer severe side effects, so doxorubicin can be left out.

## Summary

International randomised trial of the SIOPEL group: 255 children with standard-risk hepatoblastoma were randomised to pre- and post-operative cisplatin alone (n 126) or cisplatin plus doxorubicin (n 129) with delayed resection.

Complete resection was achieved in 95 and 93 percent; three-year event-free survival was 83 and 85 percent and overall survival 95 and 93 percent (median follow-up 46 months). Acute grade 3 or 4 adverse events occurred in 20.6 percent with cisplatin alone against 74.4 percent with the combination.

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Journal: New England Journal of Medicine
- Year: 2009
- DOI: 10.1056/NEJMoa0810613
- Authors: Perilongo G, Maibach R, Shafford E, et al.
- Findings: Complete resection 95 percent with cisplatin versus 93 percent with cisplatin plus doxorubicin (difference 1.4 percent, 95% CI -4.1 to 7.0).; Three-year event-free survival 83 versus 85 percent; overall survival 95 versus 93 percent.; Grade 3 or 4 acute adverse events 20.6 versus 74.4 percent.
- What it means: Cisplatin monotherapy with delayed surgery is the standard for standard-risk hepatoblastoma; later SIOPEL-6 added sodium thiosulfate to protect hearing.
- Caveats: Standard-risk disease only; high-risk patients need intensified regimens such as SIOPEL-4.

## Sources

- N Engl J Med 2009: https://doi.org/10.1056/NEJMoa0810613
- PubMed: https://pubmed.ncbi.nlm.nih.gov/19846851/

## Connected records

- cancers: [Hepatoblastoma](https://onco.cc/cancers/hepatoblastoma/)
- drugs: [Cisplatin](https://onco.cc/drugs/cisplatin/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/)
- trials: [SIOPEL-3](https://onco.cc/trials/siopel-3/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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