Efficacy and safety of intrapericardial bleomycin for malignant pericardial effusion.

Abstract

e19687 Background: Malignant pericardial effusion (MPE) is a relatively common complication of advanced malignancies including lung and breast cancer. Although pericardial drainage results in good palliation of symptoms, it is often inadequate to prevent recurrence of effusion. Intrapericardial (IP) sclerotherapy is associated to good results in terms of recurrence prevention. Absence of MPE at 30 days (d) after sclerosis can be observed in 70 to 90% of treated patients (pts). In comparison to tetracyclines and other agents used for IP sclerosis, bleomycin appears to be effective and safe. Methods: We retrospectively reviewed 18 pts with MPE who had been treated with IP bleomycin at our institution from July 2004 to July 2009. Our aim was to identify the number of MPE recurrences at 30 d and treatment-related morbidity. Results: Twelve men and 6 women with a median age of 62 years were included with diagnosis of lung cancer (67%), breast cancer (11%) and others (22%). They all presented clinical and/or radiological evidence of pericardial effusion. Cytology of the effusion was positive in 8 cases out of the 17 examined (47%). There were no deaths due to initial sclerosis failure or complication of procedure. MPE recurrence developed in 4 pts (22.2%), 3 of which (75%) did so after 30 d. Mild fever (37-37.5°C) occurred in 5 pts (27.8%). Three pts (16.7%) developed atrial fibrillation with rapid ventricular response reverting to sinus rhythm after intravenous administration of amiodarone. Retrosternal pain and infection of catheter were observed in one pt (5.5%). Conclusions: Our experience with MPE is consistent with that reported in literature, supporting the use of bleomycin as IP sclerosing agent to prevent the recurrence of MPE with generally controllable morbidity. No significant financial relationships to disclose.