Heated Intra-peritoneal Chemotherapy With Doxorubicin and Cisplatin for the Treatment of Resectable, Refractory, or Recurrent Abdominal or Pelvic Tumors in Pediatric Patients, T.O.A.S.T. I.T. Study

Primary Outcome Measures

1. Incidence of adverse events of cytoreductive surgery (CRS) with heated intra-peritoneal chemotherapy (HIPEC) in this patient population [ Time Frame: Up to 6 months ]

Secondary Outcome Measures

1. Overall survival (OS) [ Time Frame: From the time of diagnosis of cancer up, assessed to 5 years ]
   Will be estimated using the Kaplan-Meier method. Patterns of tumor recurrence and survival will be assessed by reviewing routine surveillance imaging. Patient contact may be contacted by telephone.
2. Disease-free survival (DFS) [ Time Frame: From the time of diagnosis of cancer up to 5 years ]
   Patterns of tumor recurrence and survival will be assessed by reviewing routine surveillance imaging. Patient contact may be contacted by telephone.
3. Peritoneal-free recurrence [ Time Frame: From the time of diagnosis of cancer up to 5 years ]
   Patterns of tumor recurrence and survival will be assessed by reviewing routine surveillance imaging. Patient contact may be contacted by telephone.
4. Incidence of morbidity [ Time Frame: 30, 60, and, 90 days post-HIPEC procedure ]
   Will be measured using the Clavien Dindo scale and the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.
5. Incidence of mortality [ Time Frame: 30 days post-HIPEC procedure ]
   Will be tracked using NCI CTCAE version 5.
6. Hospital length of stay [ Time Frame: Up to 5 years ]
   Will be tracked using NCI CTCAE version 5.
7. Progression free survival (PFS) [ Time Frame: From the time protocol treatment is initiated, assessed up to 5 years ]
   The PFS is defined as the time between initiation of protocol treatment and the first occurrence of disease. It will be defined radiologically.

Inclusion Criteria

• Patients must have resectable, primary refractory or recurrent intra-abdominal or pelvic tumors based on imaging studies with measurable disease (>= 1 cm in 2 perpendicular planes), or primary tumor with peritoneal implants in whom no known other curative treatment exists, and/or patients not on up-front clinical trial
• Evidence of macroscopic or microscopic intra-peritoneal seeding (separate from the primary tumor) identified at the time of exploratory surgery with or without primary tumor resection
• Peritoneal cancer index (PCI) =< 20 and surgeons deem high likelihood of complete residual tumor stage R0 (R0) resection
• No evidence of distant metastases at the time of enrollment
• Histologies to be considered include: rhabdomyosarcoma, liposarcoma, sarcoma (other), ovarian cancer, fallopian tube cancer, gastric cancer, colon cancer, rectal cancer, mesothelioma, and desmoplastic small-round-cell tumor
• Patients may be included in the study independent of the regimen of previous surgical, radiation, or chemotherapy treatments administered. Given the increased risk of entero-cutaneous fistulae observed in patients treated with HIPEC AFTER radiation therapy, patients may be excluded based on the assessment of risk by our radiation oncology team
• Karnofsky / Lansky performance score of >= 40 or Eastern Cooperative Oncology Group (ECOG) performance score of 3 or less
• Platelet count >= 50,000 (independent of transfusion) (performed no later than 14 days before surgery)
• Prothrombin and partial thromboplastin times =< 1.2 X normal (performed no later than 14 days before surgery)
• Total bilirubin =< 2 X normal (performed no later than 14 days before surgery)
• Serum glutamic-oxaloacetic transaminase (SGOT) =< 2 X normal (performed no later than 14 days before surgery)
• Serum glutamate pyruvate transaminase (SGPT) =< 2 X normal (performed no later than 14 days before surgery)
• Lactate dehydrogenase (LDH) =< 2 X normal (performed no later than 14 days before surgery)
• Alkaline phosphatase =< 2 X normal (performed no later than 14 days before surgery)
• Neutrophil count >= 750 (performed no later than 14 days before surgery)
• Patients must have adequate renal function defined as creatinine clearance (performed no later than 14 days before surgery) or radioisotope GFR (glomerular filtration rate) >= 70 mL/min/1.73 m^2 or a serum creatinine based on age/gender less than the following values:
  • 1 to < 2 years 0.6mg/dL for both males and females
  • 2 to < 6 years 0.8mg/dL for both males and females
  • 6 to <10 years 1.0mg/dL for both males and females
• A signed informed consent form (and assent form when appropriate) approved by the Mayo Clinic (Institutional Review Board [IRB]) will be required for patient enrollment into the study. Patients must be able to read and understand the informed consent document and must sign the informed consent indicating that they are aware of the investigational nature of this study

Exclusion Criteria

• Females who are pregnant or breast-feeding during the study period will be excluded
• Distant metastatic disease not limited to peritoneum:
  • Solid organ metastases (liver, central nervous system, lung)
  • Known bone marrow involvement
• No critical cumulative dose of previous chemotherapy (total anthracycline dose not >= 435 mg / m^2)
• Prior HIPEC within 3 months
• Patients with an active infection requiring treatment or having an unexplained febrile illness (Tmax > 99.5 Fahrenheit [F]), patients with known immune deficiency disorder or known human immunodeficiency virus infection
• Patients must not have any systemic illness which precludes them from being an operative candidate as determined by anesthesia preoperative evaluation. This includes but is not limited to, sepsis, liver failure, renal failure, cardiovascular failure, pulmonary failure
• Subjects deemed unable to comply with study and/or follow-up procedures
• Subjects with a known hypersensitivity to protocol systemic chemotherapy that was life-threatening, required hospitalization or prolongation of existing hospitalization, or resulted in persistent or significant disability or incapacitation