Zytoreduktive Chirurgie und HIPEC bei peritoneal-metastasierten Tumoren im Kindesalter

Zusammenfassung

Die Peritonealkarzinose ist ein weit fortgeschrittenes Tumorstadium mit reduzierter Überlebensrate. Durch die Einführung der zytoreduktiven Chirurgie (CRS) und der intraperitonealen hyperthermen Chemotherapie (HIPEC) konnten verbesserte Behandlungsergebnisse bei Erwachsenen im Vergleich zur alleinigen Chemotherapie erreicht werden. Die Hauptindikationen für die CRS und HIPEC bei Erwachsenen stellen primäre peritoneale Tumoren wie die Mesotheliome und Pseudomyxoma peritonei dar. Hinzu kommen die peritoneale Aussaat von gastrointestinalen Karzinomen und Ovarialkarzinomen. Bei Kindern ist die Inzidenz der Peritonealkarzinose vermutlich niedriger als bei Erwachsenen. Allerdings liegen hierzu keine verlässlichen Daten vor. Dennoch kann die Peritonealkarzinose/peritoneale Sarkomatose bei Kindern mit desmoplastischen klein- und rundzelligen Tumoren (DSRCT), Weichteilsarkomen (Rhabdomyosarkome, Leiomyosarkome, GIST oder Liposarkomen) und gastrointestinalen Karzinomen auftreten. Die CRS und HIPEC ist in jüngster Vergangenheit als neue Behandlungsalternative für Kinder mit Peritonealkarzinose/peritonealer Sarkomatose in einzelnen Zentren weltweit etabliert worden. In dieser Publikation werden die Indikationsstellung, Behandlungsregime und Komplikationen bei Kindern beschrieben.

Abstract

Peritoneal tumour dissemination represents an advanced tumour stage and survival rates are usually low. In the past, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has been established in adults leading to increased survival rates in comparison to chemotherapy alone. CRS and HIPEC are indicated in primary peritoneal tumours such as mesothelioma and pseudomyxoma peritonei, and in peritoneal metastases from gastrointestinal and ovarian cancers in adults. The incidence of peritoneal surface malignancies in children seems to be lower than in adults, but the incidence is unknown. Nevertheless, peritoneal carcinomatosis/sarcomatosis may occur in patients suffering from desmoplastic small round cell tumour (DSRCT), soft tissue sarcoma (rhabdomyosarcoma, leiomyosarcoma, GIST or liposarcoma), as well as in patients with gastrointestinal cancers. CRS and HIPEC have been established as a novel treatment option in children suffering from peritoneal carcinomatosis/sarcomatosis in very few centres worldwide. This paper reviews the indications, treatment regimens, and pitfalls of this approach in children.

Schlüsselwörter

Peritonealkarzinose - Kinderchirurgie - mesenchymaler Tumor - kolorektales Karzinom

Key words

peritoneal carcinomatosis - paediatric surgery - mesenchymal tumour - colorectal carcinoma

^* Geteilte Erstautorenschaft.

• Literatur

• 1 Beckert S, Struller F, Grischke EM et al. Chirurgische Therapie der peritonealen Metastasierung in Abhängigkeit von Tumorentität, -stadium und -charakterstik(a). Zentralbl Chir 2013; [Epub ahead of print]
• 2 Sugarbaker PH. Partial peritonectomy. Ann Surg Oncol 2012; 19: 1250
• 3 Sugarbaker PH. Peritonectomy procedures. Ann Surg 1995; 221: 29-42
• 4 Esquivel J. Current status of colorectal cancer with peritoneal carcinomatosis. Ann Surg Oncol 2010; 17: 1968-1969
• 5 Jacquet P, Sugarbaker PH. Current methodology for clinical assessment of patient with peritoneal carcinomatosis. Journal of Experimental and Clin Canc Res 1996; 15: 49-58
• 6 Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF. Leitlinienprogramm Onkologie: S3-Leitlinie Kolorektales Karzinom, Langversion 1.0, AWMF Registierungsnummer 021-007OL. Im Internet: http://leitlinienprogramm-onkologie.de/leitlinien.7.0.html Stand: 14.6.2013
• 7 Huh WW, Fitzgerald NE, Mahajan A et al. Peritoneal sarcomatosis in pediatric malignancies. Pediatr Blood Canc 2013; 60: 12-17
• 8 Randle RW, Swett KR, Shen P et al. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in peritoneal sarcomatosis. Am Surg 2013; 79: 620-624
• 9 Salti GI, Ailabouni L, Undevia S. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal sarcomatosis. Ann Surg Oncol 2012; 19: 1410-1415
• 10 Piso P, Leebmann H, März L et al. Zytoreduktive Chirurgie für maligne Tumoren des Peritoneums. Chirurg 2014; [Epub ahead of print]
• 11 Lim SJ, Cormier JN, Feig BW et al. Toxicity and outcomes associated with surgical cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with sarcomatosis. Ann Surg Oncol 2007; 14: 2309-2318
• 12 Hayes-Jordan A, Green HL, Lin H et al. Complete cytoreduction and HIPEC improves survival in desmoplastic small round cell tumor. Ann Surg Oncol 2014; 21: 220-224
• 13 Hayes-Jordan A, Green H, Ludwig J et al. Toxicity of hyperthermic intraperitoneal chemotherapy (HIPEC) in pediatric patients with sarcomatosis/carcinomatosis: early experience and phase I results. Pediatr Blood Canc 2012; 59: 395-397
• 14 Kusamura S, Baratti D, Zaffaroni N et al. Pathophysiology and biology of peritoneal carcinomatosis. World J Gastrointest Oncol 2010; 2: 12-18
• 15 Sultan I, Rodriguez-Galindo C, El-Taani H et al. Distinct features of colorectal cancer in children and adolescents: a population-based study of 159 cases. Cancer 2010; 116: 758-765
• 16 Ung L, Chua TC, David LM. Peritoneal metastases of lower gastrointestinal tract origin: a comparative study of patient outcomes following cytoreduction and intraoperative chemotherapy. J Cancer Res Clin Oncol 2013; 139: 1899-1908
• 17 Dantonello TM, Int-Veen C, Winkler P et al. Initial patient characteristics can predict pattern and risk of relapse in localized rhabdomyosarcoma. J Clin Oncol 2008; 26: 406-413
• 18 Koscielniak E, Klingebiel T. CWS-guidance for risk adapted treatment of soft tissue sarcoma and soft tissue tumors in children, adolescents, and young adults. Version 1.6.1, 2014.
• 19 Ceelen WP, Flessner MF. Intraperitoneal therapy for peritoneal tumors: biophysics and clinical evidence. Nat Rev Clin Oncol 2010; 7: 108-115
• 20 Rossi CR, Mocellin S, Pilati P et al. Pharmacokinetics of intraperitoneal cisplatin and doxorubicin. Surg Oncol Clin N Am 2003; 13: 781-794
• 21 Rossi CR, Deraco M, De Simone M et al. Hyperthermic intraperitoneal intraoperative chemotherapy after cytoreductive surgery for the treatment of abdominal sarcomatosis: clinical outcome and prognostic factors in 60 consecutive patients. Cancer 2004; 100: 1943-1950
• 22 Markmann M. Intraperitoneal antineoplastic drug delivery: rationale and results. Lancet Oncol 2003; 4: 277-283
• 23 Casper ES, Kelsen DP, Alcock NW et al. Ip cisplatin in patients with malignant ascites: pharmacokinetic evaluation and comparison with the iv route. Cancer Treat Rep 1983; 67: 235-238
• 24 Klumpp B, Aschoff P, Schwenzer N et al. Correlation of preoperative magnetic resonance imaging of peritoneal carcinomatosis and clinical outcome after peritonectomy and HIPEC after 3 years of follow-up: preliminary results. Cancer Imaging 2013; 13: 540-547
• 25 Armeanu-Ebinger S, Griessinger CM, Herrmann D et al. PET/MR imaging and optical imaging of metastatic rhabdomyosarcoma in mice. J Nucl Med 2014; 55: 1545-1551
• 26 Owusu-Agyemang P, Arunkumar R, Green H et al. Anaesthetic management and renal function in pediatric patients undergoing cytoreductive surgery with continuous hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin. Ann Surg Oncol 2012; 19: 2652-2656
• 27 Owusu-Agyemang P, Soliz J, Hayes-Jordan A et al. Safety of epidural analgesia in the perioperative care of patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 2014; 21: 1487-1493
• 28 Pelz JOW, Germer CT. Morbidität und Letalität der hyperthermen intraperitonealen Chemoperfusion. Chirurg 2013; 84: 957-961
• 29 Mohamed F, Moran BF. Morbidity and mortality with cytoreductive surgery and intraperitoneal chemotherapy: the importance of a learning curve. Cancer 2009; 15: 196-199
• 30 Levine EA, Stewart JH, Shen P et al. Intraperitoneal chemotherapy for peritoneal surface malignancy: experience with 1000 patients. J Am Coll Surg 2014; 218: 573-585
• 31 Hayes-Jordan A, Green H, Fitzgerald N et al. Novel treatment for desmoplastic small round cell tumor: hyperthermic intraperitoneal perfusion. J Pediatr Surg 2010; 45: 1000-1006
• 32 Msika S, Gruden E, Sarnacki S et al. Cytoreductive surgery associated to hyperthermic intraperitoneal chemoperfusion for desmoplastic round small cell tumor with peritoneal carcinomatosis in young patients. J Pediatr Surg 2010; 45: 1617-1621
• 33 Hayes-Jordan A, Green H, Prieto V et al. Unusual case: melanomatosis and nephroblastomatosis treated with hyperthermic intraperitoneal chemotherapy. J Pediatr Surg 2012; 47: 782-787
• 34 Reingruber B, Boettcher MI, Klein P et al. Hyperthermic intraperitoneal chemoperfusion is an option for treatment of peritoneal carcinomatosis in children. J Pediatr Surg 2007; 42: E17-E21