Long-term results of intrapericardial chemotherapeutic treatment of malignant pericardial effusions with thiotepa.
OBJECTIVE
Pericardial involvement is a common feature in different neoplastic diseases, having a strong influence on the natural history of the disease and on the quality of life of the patients. This study was performed in order to investigate the long-term effects of intracavitary treatment with thiotepa in the reduction of pericardial effusion (PE) recurrences.


METHODS
Prospective controlled intervention study.


METHODS
European Institute of Oncology, Milan, Italy.


METHODS
We studied 33 patients, 15 men and 18 women, with malignant PE, who were affected by breast cancer (11 patients), lung cancer (16 patients), microcytoma (4 patients), endometrial cancer (1 patients), and melanoma (1 patient).


METHODS
All patients with large PE, with or without cardiac tamponade, underwent percutaneous pericardiocentesis (PC) under echocardiographic monitoring. Patients with neoplastic cells in drained fluid were considered to be eligible for treatment. After drainage, the catheter was maintained in the pericardial sac for the instillation of a sclerosing, alkylating antiblastic agent (thiotepa) on days 1, 3, and 5 after the PC (15 mg at each step).


RESULTS
No procedure-related complications or side effects were observed. Two patients died because of disease progression, without PE evidence. No PE occurred in the remaining patients during the first month. Three recurrences occurred (9.1%), requiring additional PC and intrapericardial treatment. The median survival time was 115 days (range, 22 to 1,108 days) in the overall population, and 272 days in patients with breast cancer.


CONCLUSIONS
Intrapericardial treatment with thiotepa carries a minimal risk and is a repeatable procedure that can dramatically increase quality of life, or even can improve survival and the natural history of disease in cancer patients.
Martinoni
Alessandro
A
Cardiology Unit, Via Ripamonti 435, Milan, Italy. martinoni@tin.it
Cipolla
Carlo Maria
CM
Cardinale
Daniela
D
Civelli
Maurizio
M
Lamantia
Giuseppina
G
Colleoni
Marco
M
Fiorentini
Cesare
C
D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007322:Instillation, Drug; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D010490:Pericardial Effusion / Q000209:etiology / Q000628:therapy*; D020519:Pericardiocentesis; D011446:Prospective Studies; D013852:Thiotepa / Q000008:administration & dosage*; D013997:Time Factors
D018906:Antineoplastic Agents, Alkylating; D013852:Thiotepa