Intraperitoneal and intrapleural administrations of triamcinolone acetonide for control of malignant ascites and pleural effusion.

Abstract

e15505 Background: Patients with advanced gynecologic cancer often have massive ascites and pleural effusion, requiring frequent paracentesis (PC). Triamcinolone acetonide (TA) is a slowly metabolized corticosteroid. We evaluated the efficacy of intraperitoneal and intrapleural administrations of TA for control of malignant ascites and pleural effusion. Methods: We conducted a retrospective review of 48 patients with gynecologic cancer who were treated with PC followed by 400 mg of TA at our institutions since 2005. Results: Intraperitoneal TA therapy was performed in 44 patients (38 ovarian, 3 endometrial, 3 cervical) and intrapleural therapy in 4 (2 ovarian, 1 cervical, 1 endometrial), of whom 31 (65%) had recurrent cancer. Twenty-five (52%) were treated in a palliative setting, while 23 (48%) underwent chemotherapy (n=21) or surgery (n=2) following TA therapy. The median age of all patients was 60 years (range, 36-80). ECOG performance status (PS) before TA therapy was 1 in 2, 2 in 10, 3 in 28, and 4 in 8, with 43 (90%) showing improved PS after therapy. In addition, the interval between PC treatments was prolonged in 16 of 21 (76%) assessable patients. One patient complained of abdominal pain (grade 2, NCI-CTCAE ver.3) 1 day after TA therapy, while bowel perforation occurred 7 days after TA therapy in 2 ovarian cancer patients in a palliative setting. Median overall survival after therapy in a palliative setting was 20 days (range: 5-168), while it was 137 days (range: 15-1319) in other settings. Conclusions: Intraperitoneal and intrapleural TA administrations were found to be feasible and effective for patients receiving either palliative or aggressive treatment.