Neoplastic pericardial disease in lung cancer: impact on outcomes of different treatment strategies. A multicenter study.
BACKGROUND
Local (intrapericardial) chemotherapy has been reported to be useful for the treatment of neoplastic pericardial disease, but it has never been compared to systemic chemotherapy, a combination of the two and simple pericardial drainage or sclerosis.


METHODS
We analyzed the clinical and echocardiographic data of 119 patients, suffering of neoplastic pericarditis due to lung cancer (97 with non-small-cell), comparing the outcomes of four different treatment strategies (extended catheter drainage/sclerosis, systemic chemotherapy, local chemotherapy, and combined - local plus systemic - chemotherapy) at the last available follow-up or at the change of therapy after a treatment failure. The outcomes (based on semiquantitative evaluation of pericardial disease) were classified as complete, partial, no response and progressing disease.


RESULTS
A complete response was achieved in 37/53 of patients with combined, in 12/22 with local, in 5/27 with systemic chemotherapy, respectively, and in 4/17 after drainage/sclerosis (p<0.001). Overall response was achieved in 51/53 with combined, 18/22 and 16/27 with local or systemic chemotherapy, respectively, and in 5/17 with drainage/sclerosis only (p<0.001). Survival was significantly better after combined chemotherapy (p<0.001) and 12/53 patients (23%) in this subgroup survived more than 1 year. The overall response rate was higher with intrapericardial cisplatinum than with other agents (98% vs 80%, χ(2)=7.69, p<0.01).


CONCLUSIONS
Local chemotherapy, alone or with systemic chemotherapy, is effective in treating pericardial metastases from lung carcinoma, leading to a good control of pericardial effusion in 92% of cases, and to complete disappearance of effusion and masses in 65%. Combined therapy is significantly better than any other treatment. Pericardiocentesis and intrapericardial chemotherapy should be used whenever possible in lung cancer neoplastic pericardial disease, not only in case of tamponade.
Division of Cardiology, CRO, Centro di Riferimento Oncologico (National Cancer Institute), Aviano, Pordenone, Italy. clestuzzi@cro.it
Chiara
C
Lestuzzi
Alessandra
A
Bearz
Christos
C
Lafaras
Renata
R
Gralec
Eugenio
E
Cervesato
Witold
W
Tomkowski
Marzia
M
DeBiasio
Elda
E
Viel
Theodoros
T
Bishiniotis
Dimitrios N
DN
Platogiannis
Angela
A
Buonadonna
Lucia
L
Tartuferi
Rita
R
Piazza
Salvatore
S
Tumolo
Massimiliano
M
Berretta
Francesco
F
Santini
Massimo
M
Imazio
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000503:physiopathology / Q000556:secondary / Q000628:therapy*; D002404:Catheterization; D003131:Combined Modality Therapy; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006338:Heart Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000556:secondary / Q000628:therapy*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion; D010493:Pericarditis; D016896:Treatment Outcome