Original Title: Cirugía citorreductora (CRS) y quimioterapia intraperitoneal hipertérmica (HIPEC) en el tratamiento de pacientes en edad pediátrica con carcinomatosis peritoneal

Authors' objectives: This report aims to summarise the available evidence on the efficacy, safety, and cost-effectiveness of the use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of children with peritoneal carcinomatosis (PC).

Authors' results and conclusions: The search of studies on the efficacy and safety of CRS and HIPEC in children with PC retrieved seven SRs from the L·OVE platform. Of these, two SRs met the selection criteria, and these were submitted to full-text review. An evidence matrix was used and after assessing the quality of the SR, we selected the SR by Bywra et al. as the basis for synthesising the evidence. Given the recent date of publication of the selected SR, we did not search for more recent individual studies. The differences in study designs and reporting of the data meant that it was not possible to obtain a combined effect estimate for any of the outcomes of interest, and therefore, we present a narrative description of the results. Among the tumours associated with PC, desmoplastic small round cell tumours and peritoneal mesothelioma were the most commonly treated in children. The evidence suggests that patients with desmoplastic small round cell tumours have better survival rates than those with other types of tumours. Survival rates were influenced by certain characteristics, namely, the Peritoneal Cancer Index (PCI), extra-abdominal metastasis, and the degree of cytoreduction achieved. Nonetheless, given the lack of survival data in children with PC not treated with CRS and HIPEC, it was not possible to assess the impact of CRS and HIPEC on overall or disease-free survival. The heterogeneity in patient characteristics and also adjuvant therapies made it difficult to draw definitive conclusions. The quality of the evidence was very low. No cost-effectiveness studies in children were identified, although adult-based evidence suggests that CRS and HIPEC may be cost-effective. The available evidence does not allow us to draw definitive conclusions on the effect of CRS and HIPEC for treating children with PC. The very low-quality evidence identified suggests that patients without extra-abdominal metastasis, low PCI, partial response to chemotherapy and good cytoreduction results, may benefit from treatment with CRS and HIPEC. Nonetheless, further well-designed studies are required to assess the impact of this combined treatment in children with PC in terms of key outcomes, such as disease-free and overall survival, post-operative complications and the impact of this procedure on patient quality of life. We should also evaluate the cost-effectiveness of this intervention in the management of children with PC.

Authors' methods: The Epistemonikos platform Living OVerview of Evidence (L.OVE) (available from: https://iloveevidence.com/) was used for the identification of evidence, screening and selection of studies. Automated live searches were carried out in relevant databases following the Epistemonikos procedures. The results were uploaded to the L.OVE platform, and then two researchers screened the records by title and abstract with the aid of automated classifiers that excluded those with a low probability of being relevant. When more than one systematic review (SR) was identified, the overlap between them was investigated. Once studies had been selected, the relevant data were extracted, and the risk of bias was assessed using appropriate tools. The outcome measures were: overall and disease-free survival rate at 3 and 5 years (or if not available, at the end of the follow-up), postoperative complications and mortality, as well as quality of life at different time points. The GRADE approach was used to assess the reliability of the evidence identified for each outcome of interest. Further, the evidence on the cost-effectiveness of the use of CRS and HIPEC in the treatment of children with PC was assessed.

Project Status: Completed

Year Published: 2025

URL for published report: https://www.euskadi.eus/contenidos/informacion/osteba_publicacion/eu_def/adjuntos/Pacientes_Pediatria_Carcinomatosis_Peritoneal.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>