Intrapericardial instillation of mitoxantrone in palliative therapy of malignant pericardial effusion.
BACKGROUND
Pericardial effusions occurring with pericardial or myocardial metastases often cause serious complications, necessitating temporary or emergency relief by percutaneous pericardiocentesis. However, this often results in recurrences. For long-term therapy success, the intrapericardial instillation of anti-neoplastic agents is an alternative to surgical methods, which are stressful for the patient. Following our positive experiences with mitoxantrone in the treatment of malignant pleural effusions, we applied this substance for the therapy of malignant pericardial effusions.


METHODS
16 patients with cytologically verified malignant pericardial effusions (8 with bronchial carcinoma, 7 with carcinoma of the breast, 1 with adenocarcinoma of the stomach) received an intrapericardial instillation of mitoxantrone 1-3 x10-20 mg. Responses were evaluated by echocardiography 30 days after completion of therapy.


RESULTS
12 of 16 patients showed complete remission (no recurrence of a detectable effusion). 3 patients showed a partial remission (recurrence of non-drainage-dependent effusion) (CR + PR = 94%). Within the mean follow-up period of 189 days no recurrences occurred. The rate of side effects was low.


CONCLUSIONS
Intrapericardial instillation of mitoxantrone is a feasible and effective palliative method for the control of malignant pericardial effusions with little strain on the patients, short duration of hospital stay, cytotoxic characteristics of the substance with a correspondingly high rate of response and low side effects.
Musch
E
E
Allgemeine Innere Medizin, Marienhospital Bottrop, Germany.
Gremmler
B
B
Nitsch
J
J
Rieger
J
J
Malek
M
M
Chrissafidou
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006338:Heart Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary*; D006801:Humans; D007322:Instillation, Drug; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage* / Q000009:adverse effects; D010166:Palliative Care; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010496:Pericardium / Q000187:drug effects; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D008942:Mitoxantrone