Management of neoplastic pericardial effusions

Aims and background. Malignant pericardial effusion and cardiac tamponade are known complications of many advanced malignancies such as breast cancer, lung cancer,lymphomasandleukemias.Overallsurvivalislow,duetoothermetastaticlo calizations. The present study evaluated the clinical outcome and prognosis in pa tients with advanced cancer with pericardial effusion. Methods. We studied 7 patients, 4 men and 3 women, with malignant pericardial ef fusion, affected by breast cancer (2 patients), lung cancer (adenocarcinoma in 3 pa tients, microcytoma in 1 patient), and B-cell non-Hodgkin lymphoma (1 patient). All patients underwent pericardiocentesis; 3 patients underwent an instillation of thiotepa. Results. One terminal patient treated with pericardiocentesis died after only a few hours.Alltheremainingpatientsexperiencedimmediatesymptomaticimprovement and no operative complications. At the end of the study period, 2 patients were alive at59and33months,respectively,and4diedofdiseaseprogressionat1to32months (mean, 10.5). Conclusions .Pericardiocentesisisanactivenecessaryapproach,and intrapericardial treatment with thiotepa was able to reduce pericardial effusion and to prevent its reaccumulation.The standard treatment of malignant effusion and cardiac tampon ade has not yet been defined. Physicians should consider the status and the progno sis of each case. Free full text available at www.tumorionline.it