Treatment of peritoneal mesothelioma in pediatric patients

Our plain-English summary of Treatment of peritoneal mesothelioma in pediatric patients, by L.A. Cioffredi, P.A. Jänne, D.M. Jackman (Pediatric Blood & Cancer, 2009).

The study

• Authors: L.A. Cioffredi, P.A. Jänne, D.M. Jackman
• Journal: Pediatric Blood & Cancer
• Published: 2009;52(1):127-9
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Peritoneal mesothelioma is a rare and often aggressive malignancy, mostly affecting asbestos exposed adults. We present four pediatric peritoneal cases treated with a cisplatin-based doublet regimen, the standard of care in the systemic therapy of adult mesothelioma. Treatment was well tolerated, and three of these patients have achieved long-term survival. The fathers of three of the patients worked in the construction industry and may have been the source of indirect asbestos exposure.

In plain English

This brief report described four patients aged 16 to 20 with peritoneal mesothelioma (cancer of the abdominal lining) treated at Dana-Farber Cancer Institute in Boston between 2003 and 2007. Of 1,051 mesothelioma patients seen at the authors' institutions from 2000 to 2007, five had been diagnosed before age 21. All four treated patients had the epithelioid type of mesothelioma. Two had surgery to remove tumor first. All received four to six cycles of cisplatin combined with either pemetrexed or gemcitabine. With a median potential follow-up of 40.3 months, three of the four were alive and two had no disease progression. One patient died at 15 months. Only one patient had a side effect of grade 3 or worse, which was nausea. None of the patients had known occupational asbestos exposure. Three had fathers in the construction industry who, the authors wrote, may have been exposed to asbestos, though none of the fathers was known to have asbestos-related disease. The authors recommended that pediatric patients be considered for the same treatments used in adults.

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: Case series (brief report) of four patients identified from institutional databases
• Who was studied: Four patients aged 16 to 20 (two female, two male) with peritoneal mesothelioma, treated at Dana-Farber Cancer Institute, Boston, between 2003 and 2007. They came from 1,051 mesothelioma patients seen at the authors' institutions from 2000 to 2007, of whom five were diagnosed before age 21; the fifth was seen only in consultation.
• Exposure: No patient had known occupational asbestos exposure. Three of the four patients' fathers worked in the construction industry and may have been exposed to asbestos. No fiber type was named. All patients were non-smokers. One patient had earlier been treated for neuroblastoma with chemotherapy, surgery, 131I-MIBG and a stem cell transplant, but never received external beam radiation.
• Main results:
  • In all four cases the tissue type was epithelioid mesothelioma.
  • In each case, staining was positive for WT-1 and calretinin and negative for CEA, which the authors said supports the mesothelioma diagnosis.
  • Two patients had surgical debulking before chemotherapy. All received a cisplatin-based two-drug regimen (with pemetrexed or gemcitabine) for four to six cycles.
  • With a median potential follow-up of 40.3 months, three of the four patients were still alive and two remained progression-free.
  • Patient 2 (16-year-old male, cisplatin plus pemetrexed) progressed at 8.0 months and died at 15 months. Patients 1 and 3 were alive without progression at 57 and 45 months. Patient 4 progressed at 22 months and was alive at 24 months.
  • Only one patient had a toxicity of grade 3 or greater (nausea, on cisplatin plus pemetrexed). No patient required dose reduction or stopping therapy.
• The authors' conclusion: The authors recommended that pediatric patients with mesothelioma be considered for the same treatments used in adults, including surgical debulking when appropriate and intravenous chemotherapy. They suggested that the fathers' construction work may have been a source of indirect asbestos exposure, possibly in small amounts at a critical developmental stage early in life.
• Limitations the authors state:
  • The authors noted that none of the fathers was known to have asbestos-related disease, and none of the patients had clear direct asbestos exposure, so the suggested exposure source was not confirmed.

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: Peritoneal Mesothelioma, Cisplatin, Systemic Therapy, Mesothelioma, Asbestos Exposure.

Related studies

• Treatment of primary peritoneal mesothelioma by continuous hyperthermic peritoneal perfusion (CHPP) — B.J. Park, H.R. Alexander, et al. (1999)
• Treatment factors associated with long-term survival after cytoreductive surgery and regional chemotherapy for patients with malignant peritoneal mesothelioma — H.R. Alexander, D.L. Bartlett, et al. (2013)
• What made hyperthermic intraperitoneal chemotherapy an effective curative treatment for peritoneal surface malignancy: A 25-year experience with 1,125 procedures — G. Passot, D. Vaudoyer, et al. (2016)
• Malignant peritoneal mesothelioma in two pediatric patients: MR imaging findings — M. Haliloglu, F.A. Hoffer, et al. (2000)
• Pediatric Benign Cystic Peritoneal Mesothelioma — J. Durell, H. Dagash, et al. (2016)
• Unusually favorable outcome of 6 consecutive patients with diffuse malignant peritoneal mesothelioma treated with repeated doses of intraperitoneal paclitaxel. A case series — P.H. Sugarbaker, O.A. Stuart (2020)

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