Intraperitoneal bleomycin for ventriculoperitoneal spread of a hypothalamic astrocytoma

A pediatric patient is presented in whom malignant ascites developed after ventriculoperitoneal shunt placement for a suprasellar astrocytoma. Paracentesis followed by intraperitoneal bleomycin resulted in decreased fluid re-accumulation with minimal side effects. A review of the literature shows that intracavitary chemotherapy, including bleomycin, can result in safe, effective relief of malignant effusion associated with adult tumors. We have demonstrated that such treatment is also applicable to the pediatric population. In this case, the effectiveness of intracavitary bleomycin may be related to its direct action against brain glioma cells. The need for effective treatment of malignant effusions in pediatric patients is growing because of their increased survival time with tumor. We propose that intracavitary bleomycin may provide relief from this potential complication of childhood solid tumors.