title: Palliative treatment for symptomatic malignant pericardial effusion†.
abstract: Consensus has yet to emerge regarding the optimal choice of therapy in the management of malignant pericardial effusion. We review the literature to evaluate the existing evidence on the clinical effectiveness of surgical and interventional cardiological approaches. A formal literature search for all studies addressing the treatment of pericardial effusion in cancer patients was undertaken using predefined keywords. Abstracts were screened and reviewed, and data extracted. Data on intervention type, number of patients treated, number of patients surviving the procedure, effusion recurrences, need for further interventions and procedure-related complications were obtained from each study and collated in a quantitative synthesis. Of 1181 articles identified, 59 contained sufficient quantitative information to be included in the synthesis. A total of 2322 patients with symptomatic pericardial effusion were identified, of which 1399 patients were reported to have underlying malignancy. Three surgical approaches were described in a total of 19 studies, with overall success rates ranging from 93.3 to 100% and associated complication rates ranging from 4.5 to 10.3%. The remaining 40 studies reported four non-surgical treatment modalities, with success rates of 55.1-90.4% and complication rates of 5.9-32%. Data from the literature suggest that surgical drainage of the pericardium is superior to non-surgical approaches for symptom relief, effusion recurrence and morbidity; however, the lack of randomized controlled trials means that selection bias remains an important limitation to the field and definitive adequately controlled trials should be a priority.
authors.affiliation: Department of Medicine, University of Cambridge, Cambridge Institute for Medical Research (CIMR), Wellcome Trust/MRC Building, Cambridge, UK Papworth Hospital NHS Foundation Trust, Cambridge, UK gmj30@cam.ac.uk.
authors.forename: Guled M
authors.initials: GM
authors.lastname: Jama
authors.affiliation: Papworth Hospital NHS Foundation Trust, Cambridge, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Scarci
authors.affiliation: MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, UK.
authors.forename: Jack
authors.initials: J
authors.lastname: Bowden
authors.affiliation: Department of Medicine, University of Cambridge, Cambridge Institute for Medical Research (CIMR), Wellcome Trust/MRC Building, Cambridge, UK Papworth Hospital NHS Foundation Trust, Cambridge, UK Division of Respiratory Medicine, Department of Medicine, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Stefan J
authors.initials: SJ
authors.lastname: Marciniak
mesh_terms: D006328:Cardiac Catheterization; D019299:Decompression, Surgical; D004322:Drainage; D006338:Heart Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D010490:Pericardial Effusion / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D010492:Pericardiectomy; D015911:Sclerotherapy; D016896:Treatment Outcome
keywords: Malignant pericardial effusion; Sclerosant; Surgery