Intrapericardial cisplatin for the management of patients with large malignant pericardial effusion in the course of the lung cancer

Abstract

Patients with cardiac tamponade or large malignant pericardial effusion, who survived longer than 30 days after withdrawal of catheter from the pericardial space, entered the study. Main goal of investigations was: evaluation of the effectiveness and side-effects of intrapericardial administration of cisplatin in cases with malignant pericardial effusion (MPE) and cardiac tamponade or large pericardial effusion in a course of the lung cancer. Sixteen patients (four women and 12 men), mean age 53 years, median age 57 years, range 27–70 years, entered this retrospective study. After pericardiocentesis and insertion of a polyurethane catheter, pericardial fluid was drained. Malignant etiology of pericardial fluid was confirmed by cytological examination and/or by echocardiography. The diagnosis of malignancy was based upon histological examination of samples obtained from primary tumor. After confirmation of MPE cisplatin (10 mg in 20 ml normal saline) was instilled over 5 min during 1–5 consecutive days (maximal total cisplatin dose in single course: 50 mg) directly into pericardial space. If a large pericardial fluid reoccurred the courses with intrapericardial administration of cisplatin were repeated. Treatment was considered successful if the patient with malignant effusion survived 30 days without recurrence of symptoms of large pericardial effusion and no other interventions directed to the pericardium were required. In 14 (87.5%) cases malignant pericardial effusion was confirmed by cytological analysis of pericardial fluid. In two cases echocardiography confirmed metastatic tumors to the pericardium. Positive effect of intrapericardial treatment with cisplatin was achieved in 15 cases (93.75%). Mean survival period in the whole group was 6.59 months (± 6.2 months), median survival period was 3.7 months, range 2–24.1 months. There were no complications related to the pericardiocentesis. Transient atrial fibrillation was detected in three patients (18.8%). Mild nausea occurred in one case. No hypotension and retrosternal pain were observed. Cisplatin administered directly into pericardial space (CAP) seems to be effective and safe. No sclerosis of the pericardial space was observed after CAP.