Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in pediatric ovarian tumors: a novel treatment approach

Purpose: Cytoreductive
surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been
used in adults with ovarian carcinoma proving overall survival benefit in
randomized trials, but measured in months. Diffuse peritoneal disease from
pediatric type ovarian tumors is rare. We applied CRS and HIPEC to pediatric
girls with diffuse peritoneal disease as part of a clinical trial.

Methods: In all
patients complete cytoreduction was followed by HIPEC using 100 mg/m2 of
cisplatin for 90 min in a closed technique. All received neoadjuvant
chemotherapy. Patients with disease outside of the abdominal cavity were
excluded.

Results: Of 101
pediatric CRS and HIPEC operations, 8 had ovarian primary tumors and multifocal
peritoneal disease. There were three yolk sac tumors (germ cell, mixed
teratoma), one Sertoli–Leydig, one PNET of the ovary, one choriocarcinoma, one
juvenile granulosa cell tumor and one adenocarcinoma. Age ranged
4–18 years. Three of the 8 (37 %) recurred and died. The remaining
63 % are disease free 2–6 years post HIPEC. Overall survival and
relapse-free survival in this cohort was 64 and 62 %, respectively [CI
0.64 (0.34, 1); 0.62 (0.37, 1)].

Conclusions: This is
the first report of CRS and HIPEC in pediatric ovarian tumors. HIPEC may be
effective in pediatric-type ovarian tumors. More study is needed in a larger
cohort.