Abstract
A malignant pericardial effusion and a cardiac tamponade are known life-threatening complications in cancer patients. An early recognition and a prompt treatment may dramatically relieve patients of symptoms and decrease a short-term risk of death from the effusion. Although the pericardial involvement by malignancy is the leading cause, other etiological factors need exclusion before the final treatment strategy is determined. The treatment of malignant pericardial effusions must be individualized with a consideration given to the patient’s condition and tumor type, the success rates and risks of the various treatment modalities, and their local availability and expertise. The initial relief of symptoms is achieved, in most cases, with a percutaneous pericardiocentesis. A subsequent drainage of the pericardial effusion with an indwelling catheter and a local sclerotherapy and/or chemotherapy alleviates the effusion without recurrence in most of the patients. These procedures are associated with low morbidity and mortality and are preferred in the initial management of symptomatic malignant pericardial effusions. Recommended therapy for a recurrent pericardial effusion include: a repetition of pericardiocentesis and intrapericardial instillation of agents with both sclerosing and cytostatic activity, a percutaneous balloon pericardiotomy, or a surgical treatment.
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References
Cullinane CA, Paz IB, Smith D, et al; Prognostic factors in the surgical management of pericardial effusion in the patient with concurrent malignancy. Chest. 2004;125(4):1328–34.
Wilkes JD, Fidias P, Vaickus L, et al; Malignancy-related pericardial effusion. 127 cases from the Roswell Park Cancer Institute. Cancer. 1995;76(8):1377–87.
Marcy PY, Bondiau PY, Brunner P. Percutaneous treatment in patients presenting with malignant cardiac tamponade. Eur Radiol. 2005;15(9):2000–9.
Martinoni A, Cipolla CM, Civelli M, et al; Intrapericardial treatment of neoplastic pericardial effusions. Herz. 2000;25(8):787–93.
Murthy SC, Rozas MS, Adelstein DJ, et al; Induction chemoradiotherapy increases pleural and pericardial complications after esophagectomy for cancer. J Thorac Oncol. 2009;4(3):395–403.
Wei X, Liu HH, Tucker SL, et al; Risk factors for pericardial effusion in inoperable esophageal cancer patients treated with definitive chemoradiation therapy. Int J Radiat Oncol Biol Phys. 2008;70(3):707–14.
Dosios T, Theakos N, Angouras D, et al; Risk factors affecting the survival of patients with pericardial effusion submitted to subxiphoid pericardiostomy. Chest. 2003;124(1):242–6.
Krishnan GS, Chaudhary V, Al-Janadi A, et al; BCNU toxicity presenting with a large pericardial and pleural effusion. Ann Transplant. 2008;13(1):44–7.
Vogl DT, Glatstein E, Carver JR, et al; Gemcitabine-induced pericardial effusion and tamponade after unblocked cardiac irradiation. Leuk Lymphoma. 2005;46(9):1313–20.
Kelly K, Swords R, Mahalingam D, et al; Serosal inflammation (pleural and pericardial effusions) related to tyrosine kinase inhibitors. Target Oncol. 2009;4(2):99–105.
Lev A, Amariglio N, Spirer Z, et al; Specific self-antigen-driven immune response in pericardial effusion as an isolated GVHD manifestation. Bone Marrow Transplant. 2010;45:1084–1087. (Epub: 2009 Nov 16).
Yonemori K, Kunitoh H, Tsuta K, et al; Prognostic factors for malignant pericardial effusion treated by pericardial drainage in solid-malignancy patients. Med Oncol. 2007;24(4):425–30.
Martinoni A, Cipolla CM, Cardinale D, et al; Long-term results of intrapericardial chemotherapeutic treatment of malignant pericardial effusions with thiotepa. Chest. 2004;126:1412–16.
Maisch B, Seferovic PM, Ristic AD, et al; Guidelines on the diagnosis and management of pericardial diseases. Executive summary. Eur Heart J. 2004;25:587–610.
Vaitkus PT, Herrmann HC, LeWinter MM. Treatment of malignant pericardial effusion. JAMA. 1994;272(1):59–64.
Dequanter D, Lothaire P, Berghmans T, et al; Severe pericardial effusion in patients with concurrent malignancy: a retrospective analysis of prognostic factors influencing survival. Ann Surg Oncol. 2008;15(11):3268–71.
Girardi LN, Ginsberg RJ, Burt ME. Pericardiocentesis and intrapericardial sclerosis: effective therapy for malignant pericardial effusions. Ann Thorac Surg. 1997;64:1422–28.
Swanson N, Mirza I, Wijesinghe N. Primary percutaneous balloon pericardiotomy for malignant pericardial effusion. Catheter Cardiovasc Interv. 2008;71(4):504–7.
Kunitoh H, Tamura T, Shibata T, et al; A randomised trial of intrapericardial bleomycin for malignant pericardial effusion with lung cancer (JCOG9811). Br J Cancer. 2009;100(3):464–9.
Tomkowski WZ, Filipecki S. Intrapericardial cisplatin for the management of patients with large malignant pericardial effusion in the course of the lung cancer. Lung Cancer. 1997;16(2–3):215–22.
Moriya T, Takiguchi Y, Tabeta H, et al; Controlling malignant pericardial effusion by intrapericardial carboplatin administration in patients with primary non-small-cell lung cancer. Br J Cancer. 2000;83(7):858–62.
Gross JL, Younes RN, Deheinzelin D, et al; Surgical management of symptomatic pericardial effusion in patients with solid malignancies. Ann Surg Oncol. 2006;13(12):1732–8.
Shimizu S, Yajima M, Yoshii A, et al; Malignant pericardial effusion and cardiac tamponade originating from uterine carcinosarcoma. Arch Gynecol Obstet. 2009;279(3):373–5.
Nojiri S, Yumino Y, Sato K, et al; A case of pericardial malignant mesothelioma accompanied by primary lung adenocarcinoma. Nihon Kokyuki Gakkai Zasshi. 2009;47(2):104–9.
Petersen EE, Shamshirsaz AA, Brennan TM, et al; Malignant pericardial effusion with cardiac tamponade in ovarian adenocarcinoma. Arch Gynecol Obstet. 2009;280(4):675–8.
Laham RJ, Cohen DJ, Kuntz RE, et al; Pericardial effusion in patients with cancer: outcome with contemporary management strategies. Heart. 1996;75(1):67–71.
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Svoboda, M. (2010). Malignant Pericardial Effusion and Cardiac Tamponade (Cardiac and Pericardial Symptoms). In: Olver, I. (eds) The MASCC Textbook of Cancer Supportive Care and Survivorship. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-1225-1_9
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DOI: https://doi.org/10.1007/978-1-4419-1225-1_9
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