Byrwa David J, Twist Clare J, Skitzki Joseph, Repasky Elizabeth, Ham P Ben, Gupta Ajay
Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14203, USA.
Division of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA.
Cancers (Basel). 2023 May 18;15(10):2815. doi: 10.3390/cancers15102815.
Hyperthermic intraperitoneal chemotherapy (HIPEC) can directly target microscopic peritoneal disease, has achieved regular consideration in the treatment of several adult cancer types, and is more recently being studied in pediatrics. This review paper provides an overview of the use of this modality in pediatrics in order to identify medication choice, discuss post-operative morbidity and mortality, and evaluate impact on overall survival. Four databases were searched including Scopus, PubMed, Embase, and CINAHL and ultimately 37 papers documenting the use of this modality comprising 264 pediatric patients were included. Malignancies treated include desmoplastic small round cell tumor, rhabdomyosarcoma, angiosarcoma, colorectal carcinoma, and mesothelioma, with several rarer tumor types. Cisplatin was the most commonly used drug for HIPEC at varying concentrations for 30-90 min in duration at temperatures of approximately 41-42 °C. Reported toxicities were generally self-limited and there was no post-operative mortality. The impact on overall survival versus systemic chemotherapy and debulking surgery is uncertain due to lack of clinical trials and very small sample size across tumor subsets and the overall pediatric population. The relationship between degree of tumor burden and extent of surgical debulking needs to be further clarified. Future directions include prospective clinical trials, establishment of patient databases to facilitate standardization of HIPEC in pediatric patients, and additional approaches to optimize HIPEC.
热腹腔内化疗（HIPEC）可直接针对微小的腹膜疾病，已在几种成人癌症类型的治疗中得到常规考虑，最近也在儿科领域进行研究。这篇综述文章概述了这种治疗方式在儿科的应用情况，以确定药物选择、讨论术后发病率和死亡率，并评估其对总生存期的影响。检索了四个数据库，包括Scopus、PubMed、Embase和CINAHL，最终纳入了37篇记录该治疗方式应用情况的论文，共涉及264例儿科患者。所治疗的恶性肿瘤包括促结缔组织增生性小圆细胞肿瘤、横纹肌肉瘤、血管肉瘤、结直肠癌和间皮瘤，以及几种较为罕见的肿瘤类型。顺铂是HIPEC最常用的药物，在约41 - 42°C的温度下，以不同浓度持续使用30 - 90分钟。报告的毒性反应通常为自限性，且无术后死亡病例。由于缺乏临床试验，且各肿瘤亚组和整个儿科人群的样本量非常小，HIPEC对总生存期与全身化疗及肿瘤减灭术相比的影响尚不确定。肿瘤负荷程度与手术减瘤范围之间的关系需要进一步阐明。未来的方向包括开展前瞻性临床试验、建立患者数据库以促进儿科患者HIPEC的标准化，以及优化HIPEC的其他方法。
