INTRUDUCTION: Complete cytoreduction combined with heated intraperitoneal chemotherapy has been mainly used for adult patients with intraabdominaml carcinomatosis or psedudomyxoma peritonei. Over the last ten years it has also been used for pediatric patients with various intraabdominal malignancies, mainly desmoplastic round cell tumor and other abdominal sarcomatoses. Positive effects on survival have been demonstrated for over 90 pediatric patients.
CASE PRESENTATION: An 11 years old female patient was diagnosed with ovarian yolk sac tumor 3 years ago. Initially, she underwent oophorectomy with resection of the mass, which ruptured during surgery. Following surgery, she was treated with BEP and TIC chemotherapy with initial decrease in AFP levels but subsequent increase after completion of therapy. Thereafter, additional chemotherapy lines were used, including hyperthermia treatment and bone marrow transplantation. After initial normalization of AFP, AFP increased and metronimical maintenance chemotherapy was administered. A few months following completion of this therapy, AFP increased to over 1000 with demonstrated intraabdominal and hepatic masses per PET-CT.
On April 2014, we performed complete cytoreduction including omentectomy, pelvic peritonectomy, hysterectomy, left salphingoophorectomy, anterior resection, and radiofrequency ablation for the hepatic masses, followed by intraperitoneal administration of heated cysplatinum. Post-operative convalescence was rapid. The patient was discharged home on POD 13 on a normal diet.
SUMMARY: Complete cytoreduction with heated intraperitoneal chemotherapy is a viable treatment option for pediatric patients with various intraabdominal malignancies persistent despite standard treatments or which are not amendable for standard treatments. Careful patient selection and referral to dedicated centers are mandatory.
