Treatment Of Malignant Pericardial Effusion Research Articles

Intrapericardial tetracycline sclerosis in the treatment of malignant pericardial effusion: an analysis of thirty-three cases.

Thirty-three unselected patients with cardiac tamponade secondary to malignant pericardial effusion were treated by intrapericardial instillation of tetracycline hydrochloride. Complete control of the initial signs and symptoms of tamponade was obtained in 30 patients without concomitant chemotherapy or radiotherapy. The procedure did not result in clinically significant complications. Failure of the technique was related to premature removal of the catheter by the patient (one patient) or the inability to totally remove hemorrhagic, clot-filled pericardial fluid (two patients). Survival ranged between 28-704 days and extended survival was related to the performance status and/or chemoradiosensitivity of the primary cancer. No patient successfully treated subsequently developed recurrent cardiac tamponade or alternatively, constrictive pericarditis. Tetracycline pericardial instillation remains a safe, simple, and efficacious treatment of tamponade secondary to malignant disease.

The Treatment of Malignant Pericardial Effusion in Carcinoma of the Breast

In three patients with metastatic carcinoma of the breast, control of a malignant pericardial effusion was achieved with a single pericardiocentesis followed by intensive systemic combination chemotherapy. No patient required reaspiration or any other form of local treatment. A trial of this conservative initial approach is therefore recommended in patients with pericardial effusions due to breast carcinoma. Its use in those with other tumours likely to be sensitive to systemic chemotherapy warrants further evaluation.

Conservative management of malignant pericardial effusion.

The traditional approach to treatment of malignant pericardial effusion has been surgical, with establishment of a pericardial window. Conservative management with local instillation of chemotherapeutic agents and/or focal radiotherapy has received less attention, particularly when solid tumors have been causative. This series of 5 patients with antemortem diagnoses of malignant pericardial disease had predominant pericardial effusion rather than tumor encasement as the basis for tamponade. These 5 patients received initial therapy with local instillation of a chemotherapeutic agent ± radiotherapy. Four of the 5 made complete responses with total disappearance of cardiac symptoms and signs. Two of the responders are dead, 4 and 12 months, respectively, after initial treatment, neither showing significant pericardial fluid at postmortem examination. Two patients are alive and asymptomatic, 40 months and 8 months, respectively, after initial therapy. A literature review of treatment of malignant pericardial effusions discloses longer symptom-free intervals in patients treated by conservative measures compared to surgical programs utilizing pericardial window accompanied by any combination of other treatment modalities.