Abstract 20072: Intrapericardial Triamcinolone in Radiation Induced and Intrapericardial Cisplatin Treatment in Malignant Pericardial Effusion Prevent Recurrence Effectively
Background: The treatment of malignant (MPE) vs. radiation induced pericardial effusion (RPE) in patients with or after diagnosis and treatment of their respective neoplastic disease differs considerably.
Methods: We identified 42 pts with MPE (69% m, mean age 58,8+13,2 y) and 15 pts (66% fem, mean age 54,7+12.4 y) with RPE by analyzing the pericardial fluid and the pericardioscopically guided epi- and pericardial biopsy for malignant cells or infiltrates. In the case of nonmalignant effusions we excluded other causes than previous radiotherapy in the last 20 years by immunohistology and PCR for cardiotropic microbial agents.
Results: In MPE we identified: lung cancer in 52,4%; breast cancer in 19,0%; Hodgkin's disease in 4,8%; esophageal cancer in 2,4%; mesothelioma in 2,4%; colon cancer in 4,8%; and undifferentiated cancer of unknown origin in 14,2%. In RPE 11 pts had previous breast cancer, 4 pts bronchus carcinoma. MPEs were treated with intrapericardial cisplatin (single instillation of 30 mg / m2 for 24 h) in addition to the tumor-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. Patients with RPE received 500mg / m2 triamcinolonacetate (Volon A) intrapericardially followed by 6 months oral treatment with colchicin (2–3x0.5 mg). Recurrence of effusion was prevented in 13 of 15 cases (86.6%) after 3 and 6 months.
Conclusions: 1) Intrapericardial treatment with cisplatin prevents recurrences of MPE effectively. The treatment was more successful in lung than in breast cancer pts. 2) In RPE sclerosing and anti-inflammatory treatment with triamcinolonacete was equally effective.
- © 2010 by American Heart Association, Inc.