腹腔热灌注化疗在儿童腹部恶性肿瘤手术中的应用研究

Initial observations of hyperthermic intraperitoneal chemotherapy for pediatric abdominal cancer

目的探讨腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)应用于儿童腹部恶性肿瘤的安全性、可行性及初步疗效。方法回顾性分析首都医科大学附属北京儿童医院肿瘤外科和保定市儿童医院肿瘤外科2019年12月至2021年5月收治的16例腹部恶性肿瘤患儿临床资料,16例患儿中位年龄5岁8个月(8个月至13岁11个月),均行手术切除(细胞减灭术或肿瘤切除术),同时术中行HIPEC。收集所有患儿临床特点、治疗过程及初步疗效。结果16例患儿中,肾母细胞瘤5例,横纹肌肉瘤4例,肾恶性横纹肌样瘤1例,未分化肉瘤1例,未成熟畸胎瘤1例,神经母细胞瘤2例,腹膜浆液性癌1例,卵巢恶性生殖细胞肿瘤1例。本次手术为初次肿瘤切除术者6例,既往曾行肿瘤切除术、本次为肿瘤复发再手术10例。16例中位腹膜癌指数(peritoneal carcinomatosis index,PCI)评分2.5分(0~21分),肿瘤切除后细胞减灭程度(completeness of cytoreduction,CC)评分0~1分。无一例围手术期死亡或出现危及生命的并发症。4例在HIPEC后30 d内出现三级不良事件。中位随访时间8个月(3.3~20个月)。本次手术后共6例患儿复发:3例因复发死亡;1例复发后经再次化疗、手术、放疗,现无瘤生存;2例复发后化疗,带瘤生存。其余10例均未出现复发,无瘤生存。中位无病生存期(disease-free survival,DFS)7.4个月(2~20个月)。结论HIPEC应用于儿童安全、可行,未增加围手术期严重并发症。短期随访显示HIPEC对小儿腹部恶性肿瘤可能有效,但长期有效性还需要增加病例及随访时间进一步验证。

Objective To explore the safety,feasibility and short-term outcomes of hyperthermic intraperitoneal chemotherapy(HIPEC)for abdominal cancer in children.Methods From December 2019 to May 2021,16 patients with abdominal malignant tumor underwent surgical resection(cytoreductive surgery or tumorectomy)plus HIPEC.The median age was 68(8-167)months.Clinical characteristics,therapies and short-term outcomes were retrospectively analyzed.Results The histologic types included wilms tumor(n=5),rhabdomyosarcoma(n=4),malignant renal rhabdoid(n=1),undifferentiated sarcoma(n=1),immature teratoma(n=1),neuroblastoma(n=2),serous peritoneal carcinoma(n=1)and malignant ovarian germ cell tumor(n=1).Six cases underwent the initial operation and ten cases were re-operated for tumor recurrences.The median peritoneal carcinomatosis index(PCI)was 2.5(0-21)and the completeness of cytoreduction(CC)score(0-1)post-resection.There was no perioperative mortality or life-threatening complication.Four children had grade 3 adverse events within 30 days after surgery and HIPEC.The median follow-up period was 8(3.3-20)months.After surgery and HIPEC,six cases recurred.Three children died due to recurrence.One case had chemotherapy,surgery and radiotherapy after recurrence and survived without disease while another two cases received chemotherapy after recurrence and survived with disease.The remainders had no evidence of disease.The median disease-free survival(DFS)was 7.4(2-20)months.Conclusion HIPEC is both safe and feasible for pediatric abdominal malignant tumors.There is no onset of serious perioperative complications and adverse events are tolerable.The short-term outcomes are decent while long-term effectiveness requires more cases and extended follow-ups.