(PM P33) Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) with Cisplatin in Pediatric Patients with Peritoneal Mesothelioma: A Single Institution Experience and Long Term Follow Up

Introduction: Malignant peritoneal mesothelioma MPM is a lethal cancer, with approximately 2% of those diagnosed being less than 40 years of age, and carries an overall poor prognosis. The purpose of this study is to report long term follow up and survival of young patients with MPM after multi-modality therapy including cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods: We retrospectively investigated a prospectively maintained database including patients< 21 years old who underwent CRS and HIPEC at the National Cancer Institute (NCI) between 1994 through 2014. Follow up information for 7 patients was available through 2019 and are included in this report.

Results: Seven total young patients underwent CRS and HIPEC. Histology types included epithelioid and biphasic. Three out of the seven patients had received preoperative systemic chemotherapy before they were evaluated for surgery. At the time of the operation, Peritoneal Cancer Index ranged from 6 to 25. Completeness of cytoreduction score (CCR) was determined as 0 in 4 patients, 1 in two patients, and 2 in one patient. Post-operative complications included acute kidney injury (n=1), respiratory distress including bilateral pleural effusions and right pneumothorax requiring chest tube placement (n=2). At last available follow-up, 71% of the patients (n=5) were alive with minimal or no evaluable disease. The remaining patients (29%, n=2) passed away from their disease, 14 and 27 months, respectively, following CRS and HIPEC. Overall survival ranged between 14-281 months (median 104).

Conclusion: Malignant peritoneal mesothelioma in pediatric patients is a rare disease. Our surgical experience shows that CRS and HIPEC is feasible and safe treatment option in pediatric patients, potentially improving overall survival.