Unusual cases: melanomatosis and nephroblastomatosis treated with hyperthermic intraperitoneal chemotherapy

Our plain-English summary of Unusual cases: melanomatosis and nephroblastomatosis treated with hyperthermic intraperitoneal chemotherapy, by A. Hayes-Jordan, H. Green, V. Prieto, et al (Journal of Pediatric Surgery, 2012).

The study

• Authors: A. Hayes-Jordan, H. Green, V. Prieto, J.E. Wolff
• Journal: Journal of Pediatric Surgery
• Published: 2012;47(4):782-7
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a well-established therapy for carcinomas, mesotheliomas, and some sarcomas. However, HIPEC has not been reported in melanomatosis or nephroblastomatosis. Here we present 2 unique cases of cytoreductive surgery and HIPEC. Cytoreductive surgery followed by HIPEC was performed in a 4-year old with melanomatosis and a 12-year old with nephroblastomatosis. A 4-year-old girl presented with leptomeningeal melanoma that metastasized from a congenital nevus. She had a ventricular peritoneal shunt placed as an infant. Melanomatosis involving the meninges and peritoneal surfaces was identified by positron emission tomographic scan imaging. Extensive plaques of melanoma were removed at the time of surgery, followed by HIPEC. She had no significant postoperative complications. Her abdomen remained free of disease 7 months after treatment. A 13-year-old girl presented with a Wilms' tumor at age 10 years. She then presented to us at the second local recurrence with multiple intraabdominal tumor implants (ie, nephroblastomatosis). We performed cytoreductive surgery followed by HIPEC. She had no postoperative complications and, at 1 year post-HIPEC, had no abdominal recurrence. We conclude that HIPEC can be performed safely for rare diseases such as melanomatosis and nephroblastomatosis. Although abdominal disease control can be realized, further systemic treatment options are necessary. A review of indications for HIPEC is included.

Published by Elsevier Inc.

In plain English

This article is a report of two cases, not a study of asbestos. The article does not link either cancer to asbestos; mesothelioma appears only as background. The authors described two girls whose cancer had spread across the lining of the abdomen. One girl, aged 3 in the case description, had melanoma linked to congenital melanocytic nevus syndrome. The other, aged 12, had a second recurrence of Wilms' tumor, a kidney cancer, with multiple abdominal tumor implants. Both had surgery to remove all visible abdominal tumor, followed by heated chemotherapy (cisplatin) delivered into the abdomen. The first girl had no major complications and no abdominal recurrence at 6 months, but died of progressive leptomeningeal disease (cancer of the brain and spinal cord linings). The second girl had a wound infection but no kidney damage, and no abdominal recurrence at 12 months. She did have a left pleural recurrence (in the lining around the lung). The authors concluded that the treatment can provide safe and perhaps effective abdominal disease control. They noted the short follow-up and need for more cases.

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 report of two patients
• Who was studied: Two girls described by authors from MD Anderson Cancer Center in Houston, Texas (three authors) and The Floating Hospital for Children in Boston (one author). The first girl was aged 3 in the case description (the abstract says 4). She had congenital melanocytic nevus syndrome and melanoma that had spread to the linings of the brain and spinal cord and to the peritoneum (melanomatosis). The second girl was aged 12 and had a second recurrence of Wilms' tumor with multiple intra-abdominal tumor implants (nephroblastomatosis). Dates of treatment are not given.
• Exposure: No asbestos exposure was studied. The intervention was cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin 100 mg/m2 at 41°C for 90 minutes.
• Main results:
  • Melanoma patient: a PET scan showed complete resolution of abdominal and leptomeningeal disease 2 months after HIPEC.
  • Melanoma patient: she had no major postoperative complications. She did not begin eating by mouth until postoperative day 10.
  • Melanoma patient: she had no abdominal recurrence at 6 months of follow-up, but she died of progressive leptomeningeal disease.
  • Wilms' tumor patient: she had a wound infection but no other complications, and was discharged after 11 days.
  • Wilms' tumor patient: no nephrotoxicity (kidney damage) occurred, even though she had only one kidney.
  • Wilms' tumor patient: she had no abdominal recurrence at 12 months after surgery, but she had a left pleural recurrence, which was treated with radiation therapy.
  • In both patients the tumor progressed at sites away from the abdomen.
• The authors' conclusion: The authors concluded that HIPEC is an alternative treatment that can provide safe and perhaps effective abdominal disease control in these rare tumors.
• Limitations the authors state:
  • Follow-up was short.
  • More cases are needed to determine whether the approach is effective.

Topics

Medical terms in this study, explained in our Lexicon: HIPEC, Carcinoma, Mesothelioma, Sarcoma, Cytoreductive Surgery.

Related studies

• Toxicity of hyperthermic intraperitoneal chemotherapy (HIPEC) in pediatric patients with sarcomatosis/carcinomatosis: early experience and phase 1 results — A. Hayes-Jordan, H. Green, et al. (2012)
• Anesthetic management and renal function in pediatric patients undergoing cytoreductive surgery with continuous hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin — P. Owusu-Agyemang, R. Arunkumar, et al. (2012)
• Radiological predictors of complete cytoreduction in 59 patients with peritoneal mesothelioma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at a UK referral centre — A. Chandramohan, A. Thrower, et al. (2017)
• Peritoneal carcinomatosis from unusual cancer origins: Is there a role for hyperthermic intraperitoneal chemotherapy? — C. Honoré, D. Goéré, et al. (2016)
• Treating peritoneal mesothelioma with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. A case series and review of the literature — K. Stamou, D. Tsamis, et al. (2015)
• The use of cardiac output monitoring to guide the administration of intravenous fluid during hyperthermic intraperitoneal chemotherapy — K. Thanigaimani, F. Mohamed, et al. (2013)

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