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Treatment of Peritoneal Mesothelioma in Pediatric Patients

Source: Pediatric Blood & Cancer

Malignant Mesothelioma is most commonly a disease of the older and the elderly. The vast majority of all mesothelioma diagnoses are for men and women (although, mainly men), older that 55 or 60. However, the disease can, albeit very rarely, affect teenagers and young adults. Because mesothelioma is so rarely seen in these populations, studies are impossible to perform and little is understood about the best treatment regimens or the prognostic indicators involved in determining overall treatability. The only way to share information about these cases is through the publication of individual case reports in medical journals.

Physicians from the Dana-Farber Cancer Institute and from Brigham & Women’s Hospital have recently published an article on their treatment of four pediatric peritoneal mesothelioma cases. The case reports describe how the physicians treated these patients and how each responded to these therapies. They close the article with a number of recommendations regarding the future treatment of pediatric mesothelioma cases.

Case Reports

The authors report on four cases of pediatric mesothelioma:

  • A previously healthy 17-year-old female with a number of symptoms, including deep vein thrombosis of the left arm, a left-side pleural effusion and an unknown pelvic mass. Fluid in her peritoneum tested positive for mesothelioma.
  • A previously healthy 16-year-old male with pelvic pain and weight loss, among other symptoms, had a biopsy of a diffuse tumor mass in his pelvis which revealed peritoneal mesothelioma.
  • A previously healthy 20-year-old male with a Klebsiella pneumonia, pleural effusion and a mass in the tissue surrounding his kidneys tested positive for peritoneal mesothelioma.
  • A 16-year-old female with a prior cancer history (neuroblastoma at 12) who had achieved complete remission, presented with abdominal pain that was discovered to be caused by peritoneal mesothelioma.

None of the patients had any personal risk factors for mesothelioma, and none were smokers. However, three of them had fathers who were likely exposed to asbestos during their work in construction. None of the men had any evidence of pleural mesothelioma or peritoneal mesothelioma, but we know that the disease can affect the children and spouses of exposed workers before they are diagnosed, or even if they are never diagnosed.

Treatment Regimen and Response

After the patients were diagnosed with peritoneal mesothelioma, they all received the same basic treatments as an adult would receive. All of the patients received systematic chemotherapy using pemetrexed and cisplatin; two of the patients received surgical debulking prior to their chemotherapy.

The median survival for the group was 40.3 months. At the time the article was published, three of the four were still alive. Two of these were progression free at 45 and 57 months, respectively, while the third demonstrated some progression at 22 months, but will still alive at 24 months.

Conclusion

The authors conclude their article by raising the question as to the relationship between asbestos exposure and the development of either pleural mesothelioma or peritoneal mesothelioma, especially in pediatric cases. They note that while the incidence of the pleural disease is to be expected based on the way in which these exposures occur, the reasons for the development of peritoneal mesothelioma are still unknown. They wonder if the precise nature of the exposures—whatever they may be, as the question remains totally open for these four patients—may explain the development of peritoneal disease in place of pleural disease.

They also conclude that, where applicable, pediatric cases should be treated in the same manner as adult cases are treated: they should receive debulking surgery if possible and intravenous systemic chemotherapy. The authors also believe that these patients should be eligible for enrollment in adult-focused clinical trials.

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