Aurélien Scalabre1, Pascale Philippe-Chomette2, Guillaume Passot3,4, Daniel Orbach5, Dominique Elias6, Nadège Corradini7, Laurence Brugières8, Simon Msika9, Marc-David Leclair10, Solène Joseph10, Cécile Brigand11, François Becmeur12, Christine Soler13, Denis Pezet14, Johan Gagniere14, Olivier Glehen3, Sabine Sarnacki15. 1. Department of Pediatric Surgery, University Hospital of Saint-Etienne, Faculty of Medicine Jacques Lisfranc, PRES Lyon 42023, Jean Monnet University, Saint-Etienne, France. 2. Department of Pediatric Surgery, University Paris 7 Denis Diderot, Hôpital, Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France. 3. Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France. 4. EMR 37-38, Lyon 1 University, Lyon, France. 5. Department of Pediatric, Adolescent and Young Adult Oncology, Institut Curie, Paris, France. 6. Department of Oncologic Surgery, Gustave Roussy, Cancer Center, Grand Paris, France. 7. Departments of Oncology and Clinical Research, Centre Léon Berard and Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France. 8. Department of Oncology for Child and Adolescents, Gustave Roussy, Cancer Center, Paris, France. 9. Department of Digestive Surgery, University Paris 7 Denis Diderot, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France. 10. Paediatric Surgery and Urology Department, Children University Hospital, Nantes, France. 11. Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France. 12. Department of Pediatric Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France. 13. Pediatric Hematology-Oncology Department, Hôpital l'Archet, CHU de Nice, Nice, France. 14. Digestive Surgery and Oncological Department, Hospital Estaing, Clermont-Ferrand, France. 15. Department of Pediatric Surgery, Paris Descartes University, Hôpital Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
Abstract
BACKGROUND: Efficacy and role of cytoreductive surgery (CRS) and hyperthermic peritoneal perfusion with chemotherapy (HIPEC) remain poorly documented in pediatric tumors. METHODS: This retrospective national study analyzed all pediatric patients with peritoneal tumor spread treated by CRS and HIPEC as part of a multimodal therapy in France from 2001 to 2015. RESULTS: Twenty-two patients (nine males and 13 females) were selected. The median age at diagnosis was 14.8 years (4.2-17.6). Seven had peritoneal mesotheliomas; seven, desmoplastic small round cells tumors (DSRCT); and eight, other histologic types. A complete macroscopic resection (CC-0, where CC is completeness of cytoreduction) was achieved in 16 (73%) cases. Incomplete resections were classified as CC-1 in four (18%) cases and CC-2 in two (9%) cases. Fourteen (64%) patients had complications within 30 days from HIPEC, requiring an urgent laparotomy in eight (36%) cases. Thirteen (59%) patients received adjuvant chemotherapy and four (18%) received total abdominal radiotherapy after surgery. Sixteen (72%) patients had relapse after a median time of 9.6 months (1.4-86.4) and nine (41%) eventually died after a median time of 5.3 months (0.1-36.1) from relapse. Six (27%) patients (four mesotheliomas, one pseudopapillary pancreatic tumor, and one DSRCT) were alive and in complete remission after a median follow-up of 25.0 months (5.3-78.2). The mean overall survival (OS) and disease-free survival (DFS) were 57.5 months (95% CI [38.59-76.32]) and 30.9 months (95% CI [14.96-46.77]). Patients with a peritoneal mesothelioma had a significantly better OS (p = 0.015) and DFS (p = 0.028) than other histologic type. CONCLUSIONS: In this national series, outcomes of HIPEC are encouraging for the treatment of peritoneal mesothelioma in children.
BACKGROUND: Efficacy and role of cytoreductive surgery (CRS) and hyperthermic peritoneal perfusion with chemotherapy (HIPEC) remain poorly documented in pediatric tumors. METHODS: This retrospective national study analyzed all pediatric patients with peritoneal tumor spread treated by CRS and HIPEC as part of a multimodal therapy in France from 2001 to 2015. RESULTS: Twenty-two patients (nine males and 13 females) were selected. The median age at diagnosis was 14.8 years (4.2-17.6). Seven had peritoneal mesotheliomas; seven, desmoplastic small round cells tumors (DSRCT); and eight, other histologic types. A complete macroscopic resection (CC-0, where CC is completeness of cytoreduction) was achieved in 16 (73%) cases. Incomplete resections were classified as CC-1 in four (18%) cases and CC-2 in two (9%) cases. Fourteen (64%) patients had complications within 30 days from HIPEC, requiring an urgent laparotomy in eight (36%) cases. Thirteen (59%) patients received adjuvant chemotherapy and four (18%) received total abdominal radiotherapy after surgery. Sixteen (72%) patients had relapse after a median time of 9.6 months (1.4-86.4) and nine (41%) eventually died after a median time of 5.3 months (0.1-36.1) from relapse. Six (27%) patients (four mesotheliomas, one pseudopapillary pancreatic tumor, and one DSRCT) were alive and in complete remission after a median follow-up of 25.0 months (5.3-78.2). The mean overall survival (OS) and disease-free survival (DFS) were 57.5 months (95% CI [38.59-76.32]) and 30.9 months (95% CI [14.96-46.77]). Patients with a peritoneal mesothelioma had a significantly better OS (p = 0.015) and DFS (p = 0.028) than other histologic type. CONCLUSIONS: In this national series, outcomes of HIPEC are encouraging for the treatment of peritoneal mesothelioma in children.
Authors: Zachary E Stiles; Andrew J Murphy; Doralina L Anghelescu; Christina-Lin Brown; Andrew M Davidoff; Paxton V Dickson; Evan S Glazer; Michael W Bishop; Wayne L Furman; Alberto S Pappo; John T Lucas; Jeremiah L Deneve Journal: Ann Surg Oncol Date: 2019-04-08 Impact factor: 5.344