Abstract 3909: Intrapericardial Cisplatin Treatment Prevents Effectively the Recurrence of Neoplastic Pericardial Effusion

Abstract

Background: The differential diagnosis of neoplastic (NE) vs. radiation induced pericardial effusion (RE) in malignancies is the prerequisite of an adequate intrapericardial and/or systemic treatment.

Methods: Out of 260 pts undergoing pericardiocentesis, 42 pts with pericardial effusion (69% m, mean age 58,8+13,2 y) were identified as NE,15 pts (66% fem, mean age 54,7+12.4 y) as RE. The aetiological assessment was highly effective because it was assisted by pericardioscopy, epi- and pericardial biopsy and pericardial cytology. Pericardial effusion and biopsy analyses included biochemistry, cytology, (immuno)histology, and PCR.

Results: In NE we identified: lung cancer, 52,4%; breast cancer, 19,0%; Hodgkin’s disease, 4,8%; oesophageal cancer, 2,4%; mesothelioma, 2,4%; colon cancer, 4,8%; and undifferentiated cancer of unknown origin, 14,2%. In RE 11 pts had previous breast cancer, 4 pts bronchus carcinoma but the PE was negative for them. NE were treated with intrapericardial cisplatin (single instillation of 30 mg/m² for 24 h) in addition to the tumour-specific systemic chemotherapy. It prevented recurrence of pericardial effusion during the first 3 months of the follow-up in 92,8%, and after 6 months in 83,3% of the pts. Lung cancer patients had fewer effusion relapses at the 6 months follow-up (4,5%) than breast cancer patients (37,5%)(P<0,05). Myocardial ischemia occurred after 1/42 cisplatin instillations, but there were no other complications. RE received 500mg/m² triamcinolonacetate (Volon A) intrapericardially followed by 6 months oral treatment with colchicin (3×0,5 mg). Recurrence of effusion was prevented in 13 of 15 cases (86,6%) after 3 and 6 months. With the Touhy needle and the Marburg Attacher we reach now small effusions for intrapericardial diagnosis and treatment.

Conclusions:

1. Intrapericardial treatment with cisplatin prevents recurrences of NE effectively. The treatment was more successful in lung than in breast cancer pts.

2. In RE sclerosing treatment with triamcinolonacete was equally effective.

3. Pericardioscopy adds considerably to adequate diagnosis and consecutive treatment.