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Zhu Z, Chang X, Wang J, Yang S, Qin H, Yang W, Cheng H, Meng D, Wang H. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignant tumors in children: Initial experience in a single institution. Front Surg 2023; 9:1078039. [PMID: 36713659 PMCID: PMC9875124 DOI: 10.3389/fsurg.2022.1078039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Background Peritoneal malignant tumors in children are rare but commonly associated with disease progression and poor outcome. The successful treatment experience of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in adult peritoneal carcinoma has been applied to pediatric peritoneal malignancy in recent years. However, patients with desmoplastic small round cell tumor (DSRCT) accounted for the majority of patients treated with CRS and HIPEC in previous studies. The role of CRS and HIPEC remains controversial due to the rarity of the disease and the limited sample size of studies. Additionally, the cases using CRS and HIPEC except DSRCT were mainly small case reports with unclear outcomes. We present our experience in the treatment of pediatric peritoneal malignancies using CRS and HIPEC, with more emphasis on the safety, feasibility, and short-term outcome. Methods A retrospective query from December 2019 to February 2022 identified 19 children with peritoneal malignancies who underwent CRS and HIPEC in our institution. Clinical characteristics, therapies, and outcomes were summarized and analyzed. Results The median age of the patients was 6.4 years (range, 0.7-13.9 years). The histologic types included rhabdomyosarcoma (7), Wilms tumor (2), clear cell sarcoma of the kidney (2), undifferentiated sarcoma (2), immature teratoma (1), peritoneal serous carcinoma (1), malignant rhabdoid of the kidney (1), malignant germ cell tumor (1), neuroblastoma (1), and epithelioid inflammatory myofibroblast sarcoma (1). Seven patients underwent initial operation, and 12 patients received reoperation for tumor recurrence. The median peritoneal carcinomatosis index was 5 (range, 2-21). There were no perioperative deaths or life-threatening complications of CRS and HIPEC. Two patients had grade 3 complications of wound infection and wound dehiscence. With a median follow-up time of 14 months (range, 1.5-31 months), 14 patients were alive, and 5 died of tumor recurrence. Of the 14 patients who were alive, 2 relapsed after CRS and HIPEC and then received radiotherapy and molecular-targeted therapy or chemotherapy. Conclusions CRS and HIPEC are safe and feasible in children, without increasing serious complications in the peri- and postoperative periods. The complication is acceptable. The short-term outcome shows possible effectiveness in pediatric peritoneal malignant tumors. The long-term effectiveness needs to be verified by additional cases and long-term follow-ups.
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Affiliation(s)
- Zhiyun Zhu
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaofeng Chang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jiarong Wang
- Department of Surgical Oncology, Baoding Branch of Beijing Children's Hospital, Baoding Children's Hospital, Baoding, China
| | - Shen Yang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hong Qin
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wei Yang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Haiyan Cheng
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Deguang Meng
- Department of Surgical Oncology, Baoding Branch of Beijing Children's Hospital, Baoding Children's Hospital, Baoding, China,Correspondence: Huanmin Wang Deguang Meng
| | - Huanmin Wang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China,Correspondence: Huanmin Wang Deguang Meng
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Wagner BR, Adamus AL, Hempfling L, Vahdad R, Haap-Hoff A, Heinrich B, Vázquez O, Jank P, Denkert C, Seitz G. Increasing the efficiency of hyperthermic intraperitoneal chemotherapy (HIPEC) by combination with a photosensitive drug in pediatric rhabdomyosarcoma in an animal model. Pediatr Blood Cancer 2022; 69:e29864. [PMID: 35731577 DOI: 10.1002/pbc.29864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/24/2022] [Accepted: 06/09/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) is an option in advanced peritoneal sarcomatosis. Nevertheless, CRS and HIPEC are not successful in all patients. An enhancement of HIPEC using photodynamic therapy (PDT) might be beneficial. Therefore, a combination of the photosensitizer hypericin (HYP) with HIPEC was evaluated in an animal model. PROCEDURE An established HIPEC animal model for rhabdomyosarcoma (NOD/LtSz-scid IL2Rγnullmice, n = 80) was used. All groups received HYP (100 μg/200 μl) intraperitoneally with and without cisplatin-based (30 or 60 mg/m2 ) HIPEC (37°C or 42°C, for 60 minutes) (five groups, each n = 16). Peritoneal cancer index (PCI) was documented visually and by HYP-based photodynamic diagnosis (PDD). HYP-based PDT of the tumor was performed. Tissue samples were evaluated regarding proliferation (Ki-67) and apoptosis (TUNEL). RESULTS HYP uptake was detected even in smallest tumor nodes (<1 mm) with improved tumor detection during PDD (PCI with PDD vs. PCI without PDD: 8.5 vs. 7, p < .001***). Apoptotic effects after PDT without HIPEC were limited to the tumor surface, whereas PDT after HIPEC (60 mg/m2 , 42°C) showed additional reduction of tumor proliferation in the top nine to 11 cell layers (50 μm). CONCLUSION HYP as fluorescent photosensitizer offers an intraoperative diagnostic advantage detecting intraperitoneal tumor dissemination. The combination of HYP and cisplatin-based HIPEC was feasible in vivo, showing enhanced effects on tumor proliferation and apoptosis induction across the tumor surface. Further studies combining HYP and HIPEC will follow to establish a clinical application.
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Affiliation(s)
- Benedikt R Wagner
- Department of Pediatric Surgery, University Hospital Marburg, Marburg, Germany
| | - Anna L Adamus
- Department of Pediatric Surgery, University Hospital Marburg, Marburg, Germany
| | - Laura Hempfling
- Department of Pediatric Surgery, University Hospital Marburg, Marburg, Germany
| | - Reza Vahdad
- Department of Pediatric Surgery, University Hospital Marburg, Marburg, Germany
| | | | - Benedikt Heinrich
- Department of Chemical Biology, Philipps-University Marburg, Marburg, Germany
| | - Olalla Vázquez
- Department of Chemical Biology, Philipps-University Marburg, Marburg, Germany.,Center for Synthetic Microbiology (SYNMIKRO), Marburg, Germany
| | - Paul Jank
- Department of Pathology, University Hospital Marburg, Marburg, Germany
| | - Carsten Denkert
- Department of Pathology, University Hospital Marburg, Marburg, Germany
| | - Guido Seitz
- Department of Pediatric Surgery, University Hospital Marburg, Marburg, Germany
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3
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Hull NC, Granberg CF, Gargollo PC, Thacker PG. Imaging of pre- and post-cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pediatric intraperitoneal malignancy. Pediatr Radiol 2022; 52:2254-2266. [PMID: 36207454 DOI: 10.1007/s00247-022-05424-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/09/2022] [Accepted: 06/02/2022] [Indexed: 11/24/2022]
Abstract
Although rare, pediatric peritoneal carcinomatosis does occur in primary abdominopelvic tumors. Additionally, peritoneal carcinomatosis has been described to occur as metastatic disease where the primary tumor is outside the abdominopelvic cavity. Where amenable, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) can be beneficial in disease management. However, favorable outcomes are predicated on specific tumor histology as well as proper patient selection, which significantly relies on preoperative imaging. This review gives a comprehensive, up-to-date summary on pediatric peritoneal carcinomatosis pre-surgical evaluation; where imaging is beneficial and limited; pediatric radiologists' role in helping to quantify disease; and how we, as pediatric radiologists, can help the surgeons and oncologists in the selection of patients for cytoreductive surgery and HIPEC.
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Affiliation(s)
- Nathan C Hull
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | | | | | - Paul G Thacker
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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4
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Wagner BR, Adamus AL, Sönnecken D, Vahdad R, Jank P, Denkert C, Mahnken AH, Seitz G. Establishment of a new valid animal model for the evaluation of hyperthermic intraperitoneal chemotherapy (HIPEC) in pediatric rhabdomyosarcoma. Pediatr Blood Cancer 2021; 68:e29202. [PMID: 34197033 DOI: 10.1002/pbc.29202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy has been established as a novel treatment approach for peritoneal sarcomatosis. Despite promising clinical reports, there is still a lack of knowledge regarding optimal drug usage and local effects. Therefore, we intended to establish a murine animal model for further evaluation. PROCEDURE Alveolar rhabdomyosarcoma cells were xenotransplanted into NOD/LtSz-scid IL2Rγnullmice (n = 100). The mice received a continuous intraperitoneal lavage with isotonic saline solution as control or with cisplatin (30 or 60 mg/m2 ) as treatment group for 60 minutes at 37°C or 42°C (6 subgroups, each n = 16). Tumor spread was documented by an adapted peritoneal cancer index and MRI (n = 4). Tumor and tissue samples, harvested at the end of the perfusion, were evaluated regarding morphology, proliferation, and apoptosis (H&E-, Ki-67-, cleaved caspase 3-staining, TUNEL assay). RESULTS Extensive peritoneal sarcomatosis in over 91% of the cases was observed. HIPEC was feasible without acute side effects. Ki-67 staining revealed concentration- or temperature-dependent effects of cisplatin-based HIPEC on the tumors. Although cleaved caspase-3 showed only sporadic apoptotic effects. TUNEL assay detected concentration- or temperature-dependent apoptotic effects at the outer tumor surface. MRI scans confirmed the observed tumor dissemination. CONCLUSION This is the first animal model for evaluation of HIPEC in pediatric RMS in mice. Cisplatin-based HIPEC had early effects on the proliferation whereas circumscribed apoptotic effects could be detected at the tumor surface. This model allows further insights on the possible efficiency of HIPEC in RMS. Further studies using other drug combinations and treatment will follow.
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Affiliation(s)
- Benedikt R Wagner
- Department of Pediatric Surgery, University Hospital Marburg, Marburg, Baldingerstrasse, 35033, Germany
| | - Anna L Adamus
- Department of Pediatric Surgery, University Hospital Marburg, Marburg, Baldingerstrasse, 35033, Germany
| | - Dörthe Sönnecken
- Department of Pediatric Surgery, University Hospital Marburg, Marburg, Baldingerstrasse, 35033, Germany
| | - Reza Vahdad
- Department of Pediatric Surgery, University Hospital Marburg, Marburg, Baldingerstrasse, 35033, Germany
| | - Paul Jank
- Department of Pathology, University Hospital Marburg, Marburg, Baldingerstrasse, 35033, Germany
| | - Carsten Denkert
- Department of Pathology, University Hospital Marburg, Marburg, Baldingerstrasse, 35033, Germany
| | - Andreas H Mahnken
- Department of Radiology, University Hospital Marburg, Marburg, Baldingerstrasse, 35033, Germany.,Center for Tumor Biology and Immunology, Core Facility for Small Animal MRI, Hans-Meerwein Str. 3, Marburg, 35043, Germany
| | - Guido Seitz
- Department of Pediatric Surgery, University Hospital Marburg, Marburg, Baldingerstrasse, 35033, Germany
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Sorrentino L, Serra F, Cabry F, Cauteroq N, Zmora O, Gelmini R. Peritoneal carcinomatosis from colorectal cancer in the pediatric population: Cytoreductive surgery and HIPEC. A systematic review. Eur J Surg Oncol 2020; 47:211-215. [PMID: 32888733 DOI: 10.1016/j.ejso.2020.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/28/2020] [Accepted: 08/20/2020] [Indexed: 01/23/2023] Open
Abstract
Colorectal cancer (CRC) is a rare condition in the pediatric population, but it is usually associated with worse prognosis compared to the adult population. Surgical resection is the gold standard and most effective treatment for CRC. Cytoreductive surgery (CRS) and Heated Intra-Peritoneal Chemotherapy (HIPEC) is a feasible option in resectable primary tumour with carcinomatosis and non-evidence of extra-abdominal disease. Although it is very uncommon in children when performed, CRS-HIPEC is based on the description by Sugarbaker et al. and the two most common administrated drugs are Cisplatin and Mitomycin-C. We present a review of the cases found in the literature of peritoneal carcinomatosis from CRC treated with CRS and HIPEC in children. A systematic search was performed in the major databases up to February 2020. We included all the reviews and studies reporting clinical data on pediatric patients with peritoneal colorectal carcinomatosis. Nine cases were extracted from the literature. Patient age was between 11 and 16 years old. All patients underwent neoadjuvant chemotherapy. All patients were treated with HIPEC and the majority of them received a complete cytoreduction (CC-0). At follow-up, three patients were found free from disease with an average time of follow up of 74 weeks (40-100). In 33% of cases, recurrence was described. No postoperative death within 30 days from surgery was observed. CRS and HIPEC can be a feasible option for CRC peritoneal carcinomatosis in children. Because CRC is unusual among the pediatric population, multi-institutional studies should be done to achieve larger cohorts and a more reliable analysis.
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Affiliation(s)
- Lorena Sorrentino
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena Italy Via Del Pozzo, 71 41100, Modena, Italy.
| | - Francesco Serra
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena Italy Via Del Pozzo, 71 41100, Modena, Italy.
| | - Francesca Cabry
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena Italy Via Del Pozzo, 71 41100, Modena, Italy.
| | - Nicola Cauteroq
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena Italy Via Del Pozzo, 71 41100, Modena, Italy.
| | - Osnat Zmora
- Department of General Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Roberta Gelmini
- Dept. of Surgery, University of Modena and Reggio Emilia -Via Del Pozzo, 71 41124 Modena, Italy.
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Randle RW, Swett KR, Shen P, Stewart JH, Levine EA, Votanopoulos KI. Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in Peritoneal Sarcomatosis. Am Surg 2020. [DOI: 10.1177/000313481307900624] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the treatment most likely to achieve prolonged survival for peritoneal surface disease from various primaries, yet management of peritoneal sarcomatosis is controversial as a result of the propensity of sarcomas for hematogenous spread and the paucity of effective chemotherapy. Therefore, we reviewed our experience in patients with sarcomatosis. A retrospective analysis of a prospective database of 990 procedures was performed. Eastern Cooperative Oncology Group, age, type of primary, resection status, morbidity, mortality, and outcomes were reviewed. Over 20 years, 17 cytoreductions for sarcomatosis were performed. After excluding patients with gastrointestinal stromal tumor or uterine leiomyosarcoma, 10 procedures performed in seven patients remained. Median follow-up was 84.8 months. R0/1 resection was achieved in 60 per cent. The 30-day morbidity was 50 per cent; no operative mortality rate was observed. R2 resection had no long-term survivors. The reason for death was peritoneal recurrence in 57 per cent. Median survival was 21.6 months and five-year survival was 43 per cent. Median survival for patients with peritoneal sarcomatosis treated with CRS-HIPEC is similar with the historical reported survival before introducing chemoperfusion. Although a complete cytoreduction is related to improved survival, the role of HIPEC in these patients is unknown. A multi-institutional review will help define the role of CRS-HIPEC in this population.
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Affiliation(s)
- Reese W. Randle
- Surgical Oncology Service in the Departments of General Surgery and the
| | - Katrina R. Swett
- Department of Biostatistics, Wake Forest University, Winston-Salem, North Carolina
| | - Perry Shen
- Surgical Oncology Service in the Departments of General Surgery and the
| | - John H. Stewart
- Surgical Oncology Service in the Departments of General Surgery and the
| | - Edward A. Levine
- Surgical Oncology Service in the Departments of General Surgery and the
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7
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Fields AC, Lu PW, Li GZ, Welten V, Jolissaint JS, Vierra BM, Saadat LV, Larson AC, Atkinson RB, Melnitchouk N. Current practices and future steps for hyperthermic intraperitoneal chemotherapy. Curr Probl Surg 2020; 57:100727. [PMID: 32151327 DOI: 10.1016/j.cpsurg.2019.100727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/23/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Adam C Fields
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Pamela W Lu
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - George Z Li
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Vanessa Welten
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Joshua S Jolissaint
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Lily V Saadat
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Abby C Larson
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Rachel B Atkinson
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nelya Melnitchouk
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Pariury H, Golden C, Huh WW, Cham E, Chung T, Hayes-Jordan A. Pediatric ovarian angiosarcoma treated with systemic chemotherapy and cytoreductive surgery with heated intraperitoneal chemotherapy: Case report and review of therapy. Pediatr Blood Cancer 2019; 66:e27753. [PMID: 30977252 DOI: 10.1002/pbc.27753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 12/14/2022]
Abstract
Ovarian angiosarcoma is a rare and aggressive vascular tumor, which has a 5-year overall survival of less than 30% for patients with nonmetastatic disease and almost certain death within 1 year for those with metastasis. Here, we briefly review historical approaches to therapy and present a long-term survivor in the case of an 11-year-old female with metastatic ovarian angiosarcoma. This is the second reported case to utilize heated intraperitoneal chemotherapy in the treatment of this disease. Our patient is currently alive and well 3 years after initial diagnosis, significantly longer than any reported case of advanced-stage ovarian angiosarcoma.
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Affiliation(s)
- Holly Pariury
- Department of Hematology-Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Carla Golden
- Department of Hematology-Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Winston W Huh
- Department of Hematology-Oncology, Children's Hospital of Los Angeles, Los Angeles, California
| | - Elaine Cham
- Department of Pathology, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Taylor Chung
- Department of Radiology, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Andrea Hayes-Jordan
- Department of Pediatric Surgery, University of North Carolina Children's Hospital, Chapel Hill, North Carolina
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Novel Therapy for Pediatric Angiosarcoma With Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. J Pediatr Hematol Oncol 2018; 40:e505-e510. [PMID: 29863582 DOI: 10.1097/mph.0000000000001231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The management of pediatric abdominopelvic angiosarcoma remains unclear due to limited clinical experience. Herein, we presented the first 2 pediatric patients with abdominal angiosarcoma who were treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) after neoadjuvant therapy. The first patient is alive with recurrent disease at 1-year follow-up and the second patient remains disease free after 1 year. CRS and HIPEC should be considered as a therapeutic option in the management of pediatric abdominal angiosarcomas. A multi-institutional international shared registry is needed to further evaluate the role of CRS and HIPEC in inducing remission of abdominopelvic angiosarcomas in the pediatric population.
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10
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Zmora O, Hayes-Jordan A, Nissan A, Kventsel I, Newmann Y, Itskovsky K, Ash S, Levy-Mendelovich S, Shinhar D, Ben-Yaakov A, Toren A, Bilik R. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for disseminated intra-abdominal malignancies in children-a single-institution experience. J Pediatr Surg 2018; 53:1381-1386. [PMID: 29070431 DOI: 10.1016/j.jpedsurg.2017.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/03/2017] [Accepted: 09/02/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE Our purpose was to present our institutional experience with performing complete cytoreduction surgery and heated intraoperative chemotherapy (CRS-HIPEC) for children with disseminated intraabdominal malignancies, guided by a leading international center performing CRS-HIPEC in children. METHODS Retrospective chart review of all cases of CRS-HIPEC in children in our institution, examining diagnosis, preoperative management, operative management, postoperative treatment, short term outcome including length of stay and complications, and long term outcome including survival and recurrence of disease. RESULTS 9 children underwent CRS-HIPEC over 48months. The mean age of the patients was 8years. Tumors were: rhabdomyosarcoma (RMS), mesothelioma, Sertoli-Leydig, desmoplastic small round cell tumor, colon carcinoma and Wilms' tumor. Most patients received intraperitoneal cisplatin. Short term outcome was very good with median length of hospital stay of 13days and low rate of complications. Seven patients were alive at last follow up. Five patients developed a recurrent disease. Recurrence was intraabdominal in two of these patients. CONCLUSIONS CRS-HIPEC for children with disseminated intraabdominal malignancies performed in a dedicated institution and with guidance by a leading international center can be performed safely. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Osnat Zmora
- Department of Pediatric Surgery, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Andrea Hayes-Jordan
- Departmentof Pediatric Surgery, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Aviram Nissan
- Department of General and Oncological Surgery, Chaim Sheba Medical Center, Tel- Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Kventsel
- Department of Pediatric Hematology-Oncology, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoram Newmann
- Department of Pediatric Hematology-Oncology, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kira Itskovsky
- Department of Anesthesiology, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shifra Ash
- Department of Pediatric Hematology-Oncology, Schneider Children's Hospital, 14 Kaplan St, Petah Tikva 20494, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sarina Levy-Mendelovich
- Department of Pediatric Hematology-Oncology, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Shinhar
- Department of Pediatric Surgery, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Almog Ben-Yaakov
- Department of General and Oncological Surgery, Chaim Sheba Medical Center, Tel- Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Toren
- Department of Pediatric Hematology-Oncology, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Bilik
- Department of Pediatric Surgery, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Fernández KS, McCarthy L, Antony R. Intraperitoneal bleomycin for sarcomatosis-related malignant ascites: Prolonged symptom relief. Pediatr Blood Cancer 2015; 62:1868-9. [PMID: 25833195 DOI: 10.1002/pbc.25527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/03/2015] [Indexed: 11/06/2022]
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12
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Chung EM, Biko DM, Arzamendi AM, Meldrum JT, Stocker JT. Solid Tumors of the Peritoneum, Omentum, and Mesentery in Children: Radiologic-Pathologic Correlation:From the Radiologic Pathology Archives. Radiographics 2015; 35:521-46. [DOI: 10.1148/rg.352140273] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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13
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Dayal S, Ghosh D, Moran B. Miscellaneous conditions of the peritoneal cavity--peritoneal tumors, pseudomyxoma, mesothelioma, fibroblastic reaction, cocoon, cystic lymphatic malformations, blue-bleb, and chylous ascites. Semin Pediatr Surg 2014; 23:363-8. [PMID: 25459443 DOI: 10.1053/j.sempedsurg.2014.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The peritoneum is subject to both primary neoplasia and secondary malignancy from direct, trans-coelomic, or hematogenous spread from any cancer. The knowledge base in the pediatric age group is very limited due to the rarity of peritoneal conditions in children, and much of the information is extrapolated from adult literature. There have been few reports in the pediatric population on the diagnosis and management of peritoneal conditions including peritoneal malignancy. In this article, we aim to highlight some of these conditions and the treatments available with a special emphasis on the evolving role of cytoreduction surgery and hyperthermic intraperitoneal chemotherapy in the treatment of certain peritoneal malignancies in children.
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Affiliation(s)
- Sanjeev Dayal
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Dhruv Ghosh
- Children׳s Hospital at Westmead, Westmead, Sydney, New South Wales, Australia
| | - Brendan Moran
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK.
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14
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Casey DL, Wexler LH, LaQuaglia MP, Meyers PA, Wolden SL. Favorable outcomes after whole abdominopelvic radiation therapy for pediatric and young adult sarcoma. Pediatr Blood Cancer 2014; 61:1565-9. [PMID: 24798662 DOI: 10.1002/pbc.25088] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/10/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Current Children's Oncology Group (COG) guidelines recommend 24 Gy whole abdominopelvic radiation therapy (WAP-RT) for pediatric patients with sarcoma with peritoneal dissemination and/or malignant ascites. However, WAP-RT has never been described for pediatric sarcoma excluding desmoplastic small round-cell tumor (DSRCT). The objective of this study was to evaluate feasibility, outcomes, and toxicity of WAP-RT in children with sarcoma and peritoneal dissemination. PROCEDURE Detailed records of all 10 pediatric patients with sarcoma (excluding DSRCT) treated with WAP-RT from 2001 to 2013 were reviewed. RESULTS Median age was 9.9 years (range, 1.7-33.8). Seven patients had rhabdomyosarcoma, 2 embryonal undifferentiated sarcoma of the liver, and 1 Ewing sarcoma. Patients received a median dose of 24 Gy with intensity-modulated radiation therapy (IMRT) to the whole abdomen and pelvis. Two patients did not complete treatment, one due to transfusion-resistant pancytopenia and one due to moderate acute gastrointestinal toxicity. At a median follow-up of 4.0 years, both relapse-free survival and overall survival were 100%. Acute hematologic toxicities were common, with 40% of patients developing a grade 4 hematologic toxicity. Most acute gastrointestinal toxicities were grade 1 and managed appropriately with anti-diarrheals and anti-emetics. Late effects varied, and half of patients are without long-term sequelae. CONCLUSIONS All patients remain free of disease, both locally and distantly. Although WAP-RT was associated with acute and late toxicity, treatment was feasible with supportive care. Given the excellent rates of tumor control, we recommend that all providers give WAP-RT with IMRT to patients with pediatric sarcoma and peritoneal dissemination and/or malignant ascites.
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Affiliation(s)
- Dana L Casey
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
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15
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Bautista F, Elias D, Pasqualini C, Valteau-Couanet D, Brugières L. Hyperthermic intraperitoneal chemotherapy after cytoreductive surgery for the treatment of peritoneal carcinomatosis in pediatric solid malignancies: a single institution experience. J Pediatr Surg 2014; 49:1276-9. [PMID: 25092089 DOI: 10.1016/j.jpedsurg.2014.01.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 01/24/2014] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Peritoneal carcinomatosis from abdominal tumors is an uncommon condition in children usually associated with dismal prognosis. Hyperthermic intraperitoneal chemotherapy (HIPEC) following complete macroscopic surgery has been demonstrated to be safe and of benefit in selected cases. Experience in pediatrics is scarce. METHODS We retrospectively reviewed the medical files of patients under the age of 18years with an abdominal malignancy and peritoneal carcinomatosis who had been treated with HIPEC in our institution between March 2001 and April 2012. HIPEC had been administered using the open technique with oxaliplatin (300mg/m(2)) and irinotecan (200mg/m(2)) or oxaliplatin alone (460mg/m(2)) in the peritoneal cavity for 30minutes at 43°C and an intravenous perfusion of leucovorin (20mg/m(2)) and 5-fluorouracil (400mg/m(2)). RESULTS Nine patients had undergone HIPEC. Grade 3-4 complications had occurred in seven patients and were intraabdominal (n=3) or extraabdominal (n=8). No procedure-related deaths had occurred. Four patients are alive and in complete remission after a median follow-up of 4.9years (1.7-9.6). However one relapsed after HIPEC and required additional salvage therapy. CONCLUSIONS HIPEC could be considered in patients with peritoneal carcinomatosis from primary abdominal tumors. Its complications are manageable by an experienced multidisciplinary team. There are four long-term survivors, one after a relapse.
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Affiliation(s)
- Francisco Bautista
- Pediatric Oncology Department, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Dominique Elias
- Oncology Surgery Department, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Claudia Pasqualini
- Pediatric Oncology Department, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | | | - Laurence Brugières
- Pediatric Oncology Department, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France.
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16
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Dantonello TM, Lochbühler H, Schuck A, Kube S, Godzinski J, Sköldenberg E, Ljungman G, Kosztyla D, Veit-Friedrich I, Hallmen E, Feuchtgruber S, Wessalowski R, Franke M, Bielack SS, Klingebiel T, Koscielniak E. Challenges in the local treatment of large abdominal embryonal rhabdomyosarcoma. Ann Surg Oncol 2014; 21:3579-86. [PMID: 25047462 DOI: 10.1245/s10434-014-3551-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Embryonal rhabdomyosarcoma is the most common pediatric soft tissue sarcoma. The best local treatment in large, nonmetastatic primary unresected nongenitourinary embryonal rhabdomyosarcoma of the abdomen (LARME) is however unclear. METHODS We analyzed patients with LARME treated in four consecutive CWS trials. All diagnoses were confirmed by reference reviews. Treatment included multiagent chemotherapy and local treatment of the primary tumor with surgery and/or radiotherapy. The impact of primary debulking surgery (PDS) also was studied. RESULTS One hundred patients <21 years with a median age of 4 years had LARME. Sixty-one of them had a tumor >10 cm in diameter at diagnosis. PDS was performed in 19 of 100 children. The outcomes of patients with PDS were similar to those of the other patients. In 36 children, the tumor was resected after induction chemotherapy; 60 RME were irradiated. The toxic effects of radiochemotherapy were not significantly increased compared with the nonirradiated patients. With a median follow-up of 10 years, the 5-year EFS and OS were 52 ± 10 and 65 ± 9 %, respectively. Significant risk factors in multivariate analysis were age >10 years; no achievement of complete remission; and inadequate secondary local treatment, defined as incomplete secondary resection or no radiation. CONCLUSIONS Children with LARME have a fair prognosis, despite an often huge tumor size and unfavorable primary site, if the tumors can either be resected or irradiated following induction chemotherapy. PDS was only performed in a small subgroup. Radiation performed concomitantly with chemotherapy did not increase the acute toxicity significantly.
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Affiliation(s)
- Tobias M Dantonello
- Pediatrics 5 (Oncology, Hematology, Immunology, Rheumatology, Gastroenterology and General Pedatrics), Olgahospital, Klinikum Stuttgart, Stuttgart, Germany,
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