A team of doctors at the Apollo Proton Cancer Centre (APCC) on Friday announced that they have performed Asia’s first Radical pleurectomy with Hyperthermic intrathoracic chemotherapy (HITHOC) on a 16-year-old adolescent from Kerala.
The doctors treated the unusual case with multi-step surgery involving pericardiectomy, wedge resection of the left lung and en-bloc resection of the intrathoracic mass with HITHOC.
“In early 2020, a 16-year-old adolescent was detected to have Ewing’s Sarcoma of the left intra-thoracic cavity for which the patient underwent neo-adjuvant chemotherapy followed by surgery and radiation with maintenance chemotherapy. Post-treatment the recurrence of the cancer was deducted within six months, the patient approached APCC, Chennai for further treatment. The team of clinicians examined the case and conducted tests to chart out the multi-step surgery and treatments for the unique case,” The doctors said during a press conference on Friday.
Ewing’s Sarcoma is a rare type of cancer that occurs in bones or in the soft tissue around the bones.
The surgery was performed by Dr Khader Hussain, Consultant, Surgical Oncologist (Thoracic) & Robotic Surgeon and Dr Abhijit Das, Consultant, Surgical Oncologist (Thoracic) & Robotic Surgeon, consisted of Radical pleurectomy, pericardiectomy, wedge resection of the left lung, en bloc resection of the intrathoracic mass followed by HITHOC.
“Although this condition is common among children in this particular case the malignant growth was in close proximity to the heart,” Dr. Khader Hussain, Consultant, Surgical Oncologist (Thoracic) & Robotic Surgeon told Financial Express.com.
“To get primary Ewing’s which is arising from the pleura and specific about this case, which was arising from the mediastinal pleura near the pericardium. So, it was involving very close to my heart. It was involved in segments four and segment five of the left upper lobe and segments seventh and eighth upper left lower lobe. So, it’s a very rare condition. Also, although Ewing’s is a very common adolescent childhood cancer, everybody knows that it responds very well to chemotherapy. But having a pleural base in sarcoma is very uncommon. And even if like after giving chemotherapy, after doing surgery after giving radiation therapy, if you’re not able to have a control on that, obviously this is the step forward,” he added.
This radical surgery with HITHOC is the first of its kind in Asia for an adolescent, the doctors claimed.
“The cancer was in the left intra- thoracic region and had recurred within five months of the first treatment. The tumor board carefully diagnosed and created the surgery plan where in Radical pleurectomy was conducted with HITHOC. This surgery plus HITHOC is a first of its kind for adolescents. It is generally done for adult patients. This technology has the potential to revolutionise the treatment of certain primary and secondary pleural malignancies. The patient recovered in 3 weeks and is being examined regularly to keep a check on recurrence again at present the patient is disease free for one year and he is resumed high school,” Hussain said during the press conference.
Meanwhile, Dr. Das informed that the thoracic region was majorly affected due to Ewing’s Sarcoma.
“The patient has recovered well and is regularly diagnosed with no signs of cancer recurrence at present,” Dr. Das added.
Dr. Das told Financial Express.com that the prevalence of this condition is very rare.
“…I think the literature says is that the Ewing’s Sarcoma of the tumor which is arising primarily from the pleura so far is not more than 20 to 25 cases have been reported in the literature. So, while this procedure makes unique in this patient because this is generally done in adults it has never been done an adolescents…previously the patient was taking chemotherapy and radiation and the recurrence came within six months from the time of primary treatment. After our treatment, the patient does not have any disease for a year now and he’s going happily to school. That’s what this case makes this person makes quite unique for this kind of patient,” he added.