Safety and preliminary efficacy of intraoperative Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in 100 pediatric
Jiarong Wang1, Ying Zhang2, Xiaorui Wang1
1Department of Surgical Oncology, Baoding Branch of Beijing Children's Hospital, Baoding Children's Hospital, Baoding, P.R. China.
Insights
Hyperthermic intraperitoneal chemotherapy (HIPEC) shows promise for pediatric solid tumors with low severe complications. This study found promising survival rates, but larger prospective trials are needed.
Area of Science:
- Oncology
- Surgical Oncology
- Pediatric Oncology
Background:
- Peritoneal recurrence is a significant challenge in pediatric solid tumors.
- Hyperthermic intraperitoneal chemotherapy (HIPEC) is a standard treatment for adults, but evidence in children is limited.
- This study evaluates the safety and preliminary efficacy of intraoperative HIPEC in pediatric patients.
Purpose of the Study:
- To assess the safety and preliminary efficacy of intraoperative HIPEC in children with solid tumors.
- To evaluate complication rates, recurrence patterns, and survival outcomes following HIPEC in a pediatric cohort.
Main Methods:
- Retrospective analysis of 100 children undergoing cytoreductive surgery (CRS) plus HIPEC between August 2020 and January 2024.
- HIPEC involved cisplatin, doxorubicin, or ifosfamide at 40.5-41.5°C for 60 minutes.
- Outcomes measured included complications, recurrence, and survival rates.
Main Results:
- Complete cytoreduction (CC-0) was achieved in 96% of patients.
- Most adverse events were grade 1-2 gastrointestinal toxicity (90%) and myelosuppression (93%), with no grade 4+ events or 30-day mortality.
- Median overall survival was 25.2 months, and median progression-free survival was 24.6 months.
Conclusions:
- Intraoperative HIPEC demonstrated a favorable safety profile with low rates of severe complications in pediatric patients.
- Promising survival outcomes were observed, suggesting HIPEC's potential role in managing pediatric solid tumors with peritoneal recurrence.
- Further large-scale prospective studies are warranted to validate these findings due to the retrospective design and tumor heterogeneity.
Background:
Peritoneal recurrence challenges pediatric solid tumors. HIPEC is established in adults but pediatric evidence is limited. We assessed safety and preliminary efficacy of intraoperative HIPEC in children.
Research Design And Methods:
Retrospective study of 100 children (Aug 2020-Jan 2024) undergoing cytoreductive surgery (CRS) plus HIPEC (cisplatin, doxorubicin, or ifosfamide at 40.5-41.5°C for 60 min). Outcomes included complications, recurrence, and survival.
Results:
The median peritoneal carcinomatosis index was 4.0 (IQR: 8.0), and complete cytoreduction (CC-0) was achieved in 96% of patients. Adverse events were primarily grade 1-2 gastrointestinal toxicity (90%) and myelosuppression (93%); grade 3 events occurred in 10% and 7%, respectively. No grade 4+ adverse events or 30-day mortality were observed. Transient liver enzyme elevation (49%) normalized within one month. At a median follow-up of 24.3 months, the median overall and progression-free survival were 25.2 and 24.6 months, respectively. Seven patients experienced recurrence recurred and ten died.
Conclusions:
HIPEC demonstrated low rates of severe complications and promising survival outcomes. The main limitations include the retrospective design and tumor heterogeneity. Therefore, Large-scale prospective studies are warranted to validate these findings.
