Treatment of neoplastic pericardial effusion in lung cancer: comparison of 4 different therapeutic approaches

Abstract

Purpose: The optimal treatment of neoplastic pericarditis (NP) in lung cancer (LC) is still a clinical challenge. Various treatment methods are used: pericardiocentesis (P), pericardial window (W), systemic chemotherapy (CT), local (intrapericardial) CT, combined systemic and local CT. Aim of this study is to compare 4 different approaches, all including CT, using an objective scoring system to assess the outcome. No such studies are available so far. Methods: We retrospectively reviewed the data of 146 LC patients (pts) (106 males, 40 females) with NP requiring drainage and confirmed by cytology. A neoplastic score (intrapericardial effusion and masses) was used to assess the severity of pericardial involvement at diagnosis and at the last available follow-up or when a new intervention (drainage or window) was necessary. The outcome was classified as: Complete response (CR) if no effusion or masses were detectable at follow-up; partial response (PR) if the neoplastic score was reduced and no more intervention were necessary, stable disease (SD) or progression (PD) if the score was unchanged or worsened. Results: Pericardiocentesis plus: local CT (P+L) was performed in 24 pts; systemic CT (P+S) in 44; combined (P+S+L) therapy in 55. Twenty three pts had pericardial window plus systemic CT (W+S). A complete response was obtained in 67% of pts treated with local CT (alone or with systemic CT). A complete or partial response was obtained in 96% of pts receiving P+S+L, in 91% of those that underwent W+S, and in 88% of those with P+L; CR or PR was obtained in 64% with P+S (p<0.001). A significantly longer survival was obtained with combined CT (ANOVA test p=0.001). View this table: Conclusions: The most effective treatment of NP in LC is pericardial drainage and combined CT. Pericardial window with systemic CT and drainage with local CT are also effective, but with significantly shorter survival.