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Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Children, Adolescents, and Young Adults: The First 50 Cases

  • Pediatric Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Extensive peritoneal metastatic disease is rare in children. Although usually manifested as carcinomatosis in adults, sarcomatosis is more common in children. The authors began a pediatric hyperthermic intraperitoneal chemotherapy (HIPEC) program, and this report describes their initial results from the first 50 pediatric, adolescent, and young adult patients.

Methods

A single-institution, retrospective study investigated the first 50 cytoreductive surgeries and HIPEC by one surgeon for patients 3–21 years of age. The HIPEC was added to chemotherapy and radiotherapy treatment. Demographics, outcome, and complications were recorded.

Results

The median follow-up period for the surviving patients was 21.9 months. The most common diagnoses were desmoplastic small round cell tumor (n = 21), rhabdomyosarcoma (n = 7), mesothelioma (n = 4), and other carcinoma (n = 17). Multivariate analysis showed that patients treated with HIPEC and an incomplete cytoreduction had a greater risk for recurrence than those who had a complete cytoreduction (p = 0.0002). The patients with a higher peritoneal cancer index (PCI) (i.e., a large tumor burden) had a median overall survival (OS) time of 19.9 months relative to the patients with a lower PCI score, who had a median OS of 34 months (p = 0.049). The patients without complete cytoreduction had a median OS of 7.1 months compared with 31.4 months for the patients with complete cytoreduction (p = 0.012). No perioperative mortalities occurred. The incidence of major complications was 28 %.

Conclusion

Cytoreductive surgery and HIPEC with a programmatic approach for patients 3–21 years of age is unique. The best outcome was experienced by patients with desmoplastic small round cell tumor and those with complete cytoreduction. Complete cytoreduction for patients without disease outside the abdominal cavity at the time of surgery affords the best outcome.

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Acknowledgement

This study was supported in part by MD Anderson’s Cancer Center Support Grant CA016672.

Conflict of interest

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Andrea Hayes-Jordan MD

  2. Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Holly Green PA-C, Rodrigo Mejia MD, Jose Cortes MD, Cynthia Herzog MD & Winston W. Huh MD

  3. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Heather Lin PhD

  4. Department of Anesthesiology & Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Pascal Owusu-Agyemang MD

  5. Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Andrea Hayes-Jordan MD

  6. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Nancy E. Fitzgerald MD

  7. Department of Pediatric Medicine, Texas Children’s Hospital, Houston, TX, USA

    Regina Okhuysen-Cawley MD & Mary Frances McAleer MD

  8. Department of Pediatrics/Hematology-/Oncology & BMT and Cell Therapy, Levine Children’s Hospital/Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA

    Peter Anderson MD, PhD

Authors
  1. Andrea Hayes-Jordan MD
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  2. Holly Green PA-C
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  3. Heather Lin PhD
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  4. Pascal Owusu-Agyemang MD
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  5. Rodrigo Mejia MD
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  6. Regina Okhuysen-Cawley MD
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  7. Jose Cortes MD
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  8. Nancy E. Fitzgerald MD
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  9. Mary Frances McAleer MD
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  10. Cynthia Herzog MD
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  11. Winston W. Huh MD
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  12. Peter Anderson MD, PhD
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Corresponding author

Correspondence to Andrea Hayes-Jordan MD.

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Hayes-Jordan, A., Green, H., Lin, H. et al. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Children, Adolescents, and Young Adults: The First 50 Cases. Ann Surg Oncol 22, 1726–1732 (2015). https://doi.org/10.1245/s10434-014-4289-y

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  • DOI: https://doi.org/10.1245/s10434-014-4289-y

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