Cytoreductive surgery associated to hyperthermic intraperitoneal chemoperfusion for desmoplastic round small cell tumor with peritoneal carcinomatosis in young patients

J Pediatr Surg. 2010 Aug;45(8):1617-21. doi: 10.1016/j.jpedsurg.2010.03.002.

Abstract

Purpose: Desmoplastic round small cell tumor (DRSCT) is a rare intraabdominal mesenchymal tissue neoplasm in young patients and spreads through the abdominal cavity. Its prognosis is poor despite a multimodal therapy including chemotherapy, radiotherapy, and surgical cytoreduction (CS). hyperthermic intraperitoneal chemotherapy (HIPEC) is considered as an additional strategy in the treatment of peritoneal carcinomatosis; for this reason, we planned to treat selected cases of children with DRSCT using CS and HIPEC.

Methods: Peritoneal disease extension was evaluated according to Gilly classification. Surgical cytoreduction was considered as completeness of cytoreduction-0 when no macroscopic nodule was residual; HIPEC was performed according to the open technique.

Results: We described 3 cases: the 2 first cases were realized for palliative conditions and the last one was operated on with curative intent. There was no postoperative mortality. One patient was reoperated for a gallbladder perforation. There was no other complication related to HIPEC procedure.

Conclusions: Surgical cytoreduction and HIPEC provide a local alternative approach to systemic chemotherapy in the control of microscopic peritoneal disease in DRSCT, with an acceptable morbidity, and may be considered as a potential beneficial adjuvant waiting for a more specific targeted therapy against the fusion protein.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • Adenocarcinoma / drug therapy
  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery
  • Adolescent
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Carcinoma / drug therapy*
  • Carcinoma / pathology
  • Carcinoma / surgery*
  • Carcinoma, Small Cell / drug therapy
  • Carcinoma, Small Cell / surgery
  • Chemotherapy, Cancer, Regional Perfusion / methods*
  • Combined Modality Therapy
  • Disease-Free Survival
  • Female
  • Humans
  • Hyperthermia, Induced / methods*
  • Injections, Intraperitoneal
  • Male
  • Palliative Care
  • Peritoneal Neoplasms / drug therapy*
  • Peritoneal Neoplasms / pathology
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / surgery*
  • Peritoneum / pathology
  • Peritoneum / surgery
  • Treatment Outcome
  • Tumor Burden / drug effects