Abstract 14714: Impact Of The Differential Diagnosis In Tumor Patients With Neoplastic Or Radiation Induced Pericardial Effusion
Background: The differential diagnosis of neoplastic (NE) vs. radiation induced pericardial effusion (RE) in patients with current or previous malignancies has impact on their treatment and prognosis.
Methods: From 2001 to 2010 in our registry 260 pts underwent pericardiocentesis, 42 pts with pericardial effusion (69% m, mean age 58.8+13.2 y) were identified as NE, 15 pts (66% female, mean age 54.7+12.4 y) as RE. The aetiological assessment included targeted epi- and pericardial biopsy by pericardioscopy and pericardial cytology. Pericardial effusion and biopsy analyses included biochemistry, cytology, (immuno)histology, and PCR for microbial agents..
Results: In NE the following etiologies were 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 cancer of unknown origin, 14.2%. In RE the previous tumor was breast cancer in 11 pts and bronchus carcinoma in 11 pts, but the PE was negative for neoplastic cells. NE were treated with intrapericardial cisplatin (single instillation of 30 mg / m² for 24 h) in addition to the tumour-specific systemic chemotherapy. Recurrence of pericardial effusion during the first 3 months of the follow-up was prevented in 92.8%, after 6 months in 83.3% of the pts. Lung cancer pts had fewer effusion relapses at the 6 months follow-up (4.5%) than breast cancer pts (37.5%) (P<0.05). RE received 500mg / m² triamcinolonacetate (Volon A) intrapericardially followed by 6 months oral treatment with colchicin (3x0.5 mg). Recurrence of effusion was prevented in 13 of 15 cases (86.6%) after 3 and 6 months.
Conclusions: Identification of neoplastic cells by biopsy or in cytology has obvious prognostic impact. Although recurrence of PE can be avoided by intrapericardial cis-platin the longterm prognosis is lethal. Longterm prognosis in RE is much better, intrapericardial triamcinolone also prevents recurrence of PE.
- © 2011 by American Heart Association, Inc.