Cytoreductive surgery and hyperthermic intraperitoneal perfusion with chemotherapy in children with peritoneal tumor spread: A French nationwide study over 14 years

Our plain-English summary of Cytoreductive surgery and hyperthermic intraperitoneal perfusion with chemotherapy in children with peritoneal tumor spread: A French nationwide study over 14 years, by A. Scalabre, P. Philippe-Chomette, G. Passot, et al (Pediatric Blood & Cancer, 2018).

The study

• Authors: A. Scalabre, P. Philippe-Chomette, G. Passot, D. Orbach, D. Elias, N. Corradini, L. Brugières, S. Msika, M.D. Leclair, S. Joseph, C. Brigand, F. Becmeur, C. Soler, D. Pezet, J. Gagniere, O. Glehen, S. Sarnacki
• Journal: Pediatric Blood & Cancer
• Published: 2018;65(4)
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

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.

© 2017 Wiley Periodicals, Inc.

In plain English

This retrospective study, drawn from several French centres, reviewed all 22 children and teenagers (under 18 at diagnosis) in France who were treated from 2001 to 2015 with cytoreductive surgery plus HIPEC for cancer that had spread through the lining of the abdomen. Cytoreductive surgery removes visible tumor; HIPEC washes heated chemotherapy through the abdomen. Seven had peritoneal mesothelioma, seven had desmoplastic small round cell tumors (DSRCT), and eight had other cancers. The article does not discuss asbestos. All visible tumor was removed in 16 (73%) patients. Fourteen (64%) had complications within 30 days, but no patient died immediately after surgery or from complications of HIPEC. Sixteen (72%) relapsed and nine (41%) died. All seven children with peritoneal mesothelioma were alive at last update, three after treatment for relapse. They had significantly better overall and disease-free survival than the other patients. The authors concluded that results were encouraging for peritoneal mesothelioma in children. They said the numbers for other tumor types were too small for solid conclusions, and they called for international randomized trials.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective multicentre (nationwide) case series of children treated with cytoreductive surgery and HIPEC
• Who was studied: 22 patients (9 male, 13 female) aged under 18 at diagnosis (median 14.8 years) with peritoneal tumor spread who were treated with cytoreductive surgery and HIPEC in France from 2001 to 2015. Seven had peritoneal mesothelioma (five epithelioid, one multicystic, one biphasic), seven had DSRCT, and eight had other histologic types.
• Exposure: No asbestos or other environmental exposure was studied. The article examined a treatment: cytoreductive surgery followed by heated intraperitoneal chemotherapy (HIPEC), given for 30 to 90 minutes at 40 to 44 degrees C.
• Main results:
  • Complete macroscopic resection (CC-0) was achieved in 16 of 22 patients (73%).
  • Fourteen patients (64%) had complications within 30 days of HIPEC.
  • No patient died immediately after surgery or from complications of HIPEC.
  • Sixteen patients (72%) relapsed after the procedure.
  • Nine patients (41%) died, after a median of 5.3 months (range 0.1 to 36.1 months) from relapse.
  • Six patients (27%) were alive and in complete remission: four with mesothelioma, one with a pseudopapillary pancreatic tumor and one with DSRCT.
  • For all 22 patients, mean overall survival was 57.46 months (95% CI 38.59 to 76.32) and mean disease-free survival was 30.86 months (95% CI 14.96 to 46.77).
  • For peritoneal mesothelioma, overall survival was 100% and mean disease-free survival was 61.64 months (95% CI 27.32 to 95.96).
  • Patients with mesothelioma had significantly better overall survival (p = 0.015) and disease-free survival (p = 0.028) than the other patients.
  • All seven children with mesothelioma were alive at last update, although three had been treated for relapse.
  • For DSRCT, mean overall survival was 16.46 months (95% CI 7.75 to 25.18).
  • Differences in overall and disease-free survival between complete (CC-0) and incomplete (CC-1 or CC-2) resection were not statistically significant (p = 0.4 and 0.2).
• The authors' conclusion: The authors concluded that outcomes of HIPEC for peritoneal mesothelioma in children are encouraging. They called for international randomized trials of the treatment in children.
• Limitations the authors state:
  • For tumor types other than mesothelioma, there were too few patients to draw solid conclusions.
  • For DSRCT, the separate effect of HIPEC, apart from radiotherapy, has not yet been evaluated.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, Chemotherapy, HIPEC, Multimodal Therapy, Peritoneal Mesothelioma, Desmoplastic Mesothelioma, Laparotomy, Mesothelioma.

Related studies

• Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for children, adolescents, and young adults: the first 50 cases — A. Hayes-Jordan, H. Green, et al. (2015)
• Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry — K.I. Votanopoulos, P. Sugarbaker, et al. (2018)
• Overall survival of pseudomyxoma peritonei and peritoneal mesothelioma patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can be predicted by computed tomography quantified sarcopenia — A. Galan, P. Rousset, et al. (2018)
• Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for limited peritoneal metastasis. The PSOGI international collaborative registry — A. Arjona-Sanchez, O. Aziz, et al. (2021)
• Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for disseminated intra-abdominal malignancies in children-a single-institution experience — O. Zmora, A. Hayes-Jordan, et al. (2018)
• Conversion to Complete Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma After Bidirectional Chemotherapy — F. Le Roy, M. Gelli, et al. (2017)

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