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February 27, 1987, Vol 257, No. 8 >
ARTICLE | February 27, 1987

Management of Malignant Pericardial Effusion and Tamponade FREE

Oliver W. Press, MD, PhD; Robert Livingston, MD
[+] Author Affiliations

Reprint requests to the Division of Medical Oncology, Department of Medicine, RG-08, University of Washington School of Medicine, Pacific Avenue, Seattle, WA 98195 (Dr Press).


JAMA. 1987;257(8):1088-1092. doi:10.1001/jama.1987.03390080078037
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References

THE OPTIMAL management of neoplastic cardiac tamponade has been controversial, with ardent proponents of pericardiocentesis (with or without sclerotherapy),1-3 surgical decompression,4-8 and radiation therapy9-11 as primary therapeutic modalities. In the eight years since this oncologic emergency was last reviewed in this journal,12 several informative therapeutic trials have been reported that warrant a reappraisal of the recommended interventions for this condition.

Epidemiology  Although neoplastic involvement of the heart is commonly regarded as a rare condition, a compilation of autopsy series suggests that 3.4% (642/19130) of general autopsies13-18 and 11.6% (1280/11078) of cancer autopsies13-21 demonstrate cardiac metastatic disease. Of 770 cases of cardiac metastases for which adequate information was reported, 533 (69.2%) had involvement of the pericardium.13-16,19,21 The majority of cases were clinically insignificant; however, 29% of such patients developed symptoms referable to pericardial metastases and 16% developed cardiac tamponade.22 Pericardial lesions were either

REFERENCES

1 +
Smith FE, Lane M, Hudgins PT:  Conservative management of malignant pericardial effusion . Cancer 1974;;33:47-57.
2 +
Davis S, Rambotti P, Grignani F:  Intrapericardial tetracycline sclerosis in the treatment of malignant pericardial effusion: An analysis of 33 cases . J Clin Oncol 1984;;2:631-636.
3 +
Shepherd FA, Morgan CD, Ginsberg JS, et al:  Control of malignant pericardial effusion by tetracycline sclerosis . Proc Am Soc Clin Oncol 1986;;5:246.
4 +
Gregory JR, McMurtrey MJ, Mountain CF:  A surgical approach to the treatment of pericardial effusion in cancer patients . Am J Clin Oncol 1985;; 8:319-323.
5 +
Hankins JR, Satterfield JR, Aisner J, et al:  Pericardial window for malignant pericardial effusion . Ann Thorac Surg 1980;;30:465-471.
6 +
Osuch JR, Khandekar JD, Fry WA:  Emergency subxiphoid pericardial decompression for malignant pericardial effusion . Am Surg 1985;;51:298-300.
7 +
Reitknecht F, Regal AM, Antkowiak JG, et al:  Management of cardiac tamponade in patients with malignancy . J Surg Oncol 1985;;30:19-22.
8 +
Alcan KE, Zabetakis PM, Marino ND, et al:  Management of acute cardiac tamponade by subxiphoid pericardiotomy . JAMA 1982;;247:1143-1148.
9 +
Cham WC, Freiman AH, Carstens PHB, et al:  Radiation therapy of cardiac and pericardial metastases . Radiology 1975;;114:701-704.
10 +
Martini N, Freiman AH, Watson RC, et al:  Intrapericardial instillation of radioactive chromic phosphate in malignant pericardial effusion . AJR 1977;;128:639-641.
11 +
Terry LN, Kligerman MM:  Pericardial and myocardial involvement by lymphomas and leukemias: The role of radiotherapy . Cancer 1970;;25: 1003-1008.
12 +
Lokich JJ:  The management of malignant pericardial effusions . JAMA 1973;;224:1401-1404.
13 +
Harrer WV, Lewis PL:  Metastatic tumors involving the heart and pericardium . Penn Med 1971;;74:57-60.
14 +
Hanfling SM:  Metastatic cancer to the heart . Circulation 1960;;22:474-483.
15 +
Nakayama R, Yoneyama T, Takatani O, et al:  A study of metastatic tumors to the heart, pericardium and great vessels . Jpn Heart J 1966;;7:227-234.
16 +
Kline IK:  Cardiac lymphatic involvement by metastatic tumor . Cancer 1972;;29:799-808.
17 +
Young JM, Goldman IR:  Tumor metastasis to the heart . Circulation 1954;;9:220-229.
18 +
Javier BV, Yount WJ, Hall TC, et al:  The clinical implications of cardiac metastases from solid tumors: A clinical analysis of 292 cases proved at autopsy . Neoplasma 1967;;14:561-573.
19 +
Bisel HF, Wroblewski F, LaDue JS:  Incidence and clinical manifestations of cardiac metastases . JAMA 1953;;153:712-715.
20 +
Scott RW, Garvin CF:  Tumors of the heart and pericardium . Am Heart J 1939;;17:431-439.
21 +
Skhvatsabaja LV:  Secondary malignant lesions of the heart and pericardium in neoplastic disease . Oncology 1986;;43:103-106.
22 +
Thurber DL, Edwards JE, Achor RWP:  Secondary malignant tumors of the pericardium . Circulation 1962;;26:228-241.
23 +
Goldman BS, Pearson FG:  Malignant pericardial effusion: Review of hospital experience and report of a case successfully treated by talc poudrage . Can J Surg 1965;;8:157-161.
24 +
Adenle AD, Edwards JE:  Clinical and pathologic features of metastatic neoplasms of the pericardium . Chest 1982;;81:166-169.
25 +
Hill GJ, Cohen BI:  Pleural pericardial window for palliation of cardiac tamponade due to cancer . Cancer 1970;;26:81-93.
26 +
Lopez JM, Delgado JL, Tovar E, et al:  Massive pericardial effusion produced by extracardiac malignant neoplasms . Arch Intern Med 1983;;143: 1815-1816.
27 +
Fraser RS, Viloria JB, Wang NS:  Cardiac tamponade as a presentation of extracardiac malignancy . Cancer 1980;;45:1697-1704.
28 +
Theologides A:  Neoplastic cardiac tamponade . Semin Oncol 1978;;5:181-191.
29 +
Krikorian JG, Hancock EW:  Pericardiocentesis . Am J Med 1978;;65:808-814.
30 +
Guberman BA, Fowler NO, Engel PJ, et al:  Cardiac tamponade in medical patients . Circulation 1981;;64:633-640.
31 +
Callaham ML:  Pericardiocentesis in traumatic and nontraumatic cardiac tamponade . Ann Emerg Med 1984;;13:924-945.
32 +
Williams C, Soutter L:  Pericardial tamponade . Arch Intern Med 1956;;94:571-584.
33 +
Cohen JL:  Neoplastic pericarditis . Cardiovasc Clin 1976;;7:257-269.
34 +
McKenna RJ, Ali MK, Ewer MS, et al:  Pleural and pericardial effusions in cancer patients . Curr Probl Cancer 1985;;9:1-44.
35 +
Wong B, Murphy J, Chang CJ, et al:  The risk of pericardiocentesis . Am J Cardiol 1979;;44:1110-1114.
36 +
Bitran JD, Evans R, Brown C:  The management of cardiac tamponade in patients with breast cancer . J Surg Oncol 1984;;27:42-44.

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1 +
Smith FE, Lane M, Hudgins PT:  Conservative management of malignant pericardial effusion . Cancer 1974;;33:47-57.
2 +
Davis S, Rambotti P, Grignani F:  Intrapericardial tetracycline sclerosis in the treatment of malignant pericardial effusion: An analysis of 33 cases . J Clin Oncol 1984;;2:631-636.
3 +
Shepherd FA, Morgan CD, Ginsberg JS, et al:  Control of malignant pericardial effusion by tetracycline sclerosis . Proc Am Soc Clin Oncol 1986;;5:246.
4 +
Gregory JR, McMurtrey MJ, Mountain CF:  A surgical approach to the treatment of pericardial effusion in cancer patients . Am J Clin Oncol 1985;; 8:319-323.
5 +
Hankins JR, Satterfield JR, Aisner J, et al:  Pericardial window for malignant pericardial effusion . Ann Thorac Surg 1980;;30:465-471.
6 +
Osuch JR, Khandekar JD, Fry WA:  Emergency subxiphoid pericardial decompression for malignant pericardial effusion . Am Surg 1985;;51:298-300.
7 +
Reitknecht F, Regal AM, Antkowiak JG, et al:  Management of cardiac tamponade in patients with malignancy . J Surg Oncol 1985;;30:19-22.
8 +
Alcan KE, Zabetakis PM, Marino ND, et al:  Management of acute cardiac tamponade by subxiphoid pericardiotomy . JAMA 1982;;247:1143-1148.
9 +
Cham WC, Freiman AH, Carstens PHB, et al:  Radiation therapy of cardiac and pericardial metastases . Radiology 1975;;114:701-704.
10 +
Martini N, Freiman AH, Watson RC, et al:  Intrapericardial instillation of radioactive chromic phosphate in malignant pericardial effusion . AJR 1977;;128:639-641.
11 +
Terry LN, Kligerman MM:  Pericardial and myocardial involvement by lymphomas and leukemias: The role of radiotherapy . Cancer 1970;;25: 1003-1008.
12 +
Lokich JJ:  The management of malignant pericardial effusions . JAMA 1973;;224:1401-1404.
13 +
Harrer WV, Lewis PL:  Metastatic tumors involving the heart and pericardium . Penn Med 1971;;74:57-60.
14 +
Hanfling SM:  Metastatic cancer to the heart . Circulation 1960;;22:474-483.
15 +
Nakayama R, Yoneyama T, Takatani O, et al:  A study of metastatic tumors to the heart, pericardium and great vessels . Jpn Heart J 1966;;7:227-234.
16 +
Kline IK:  Cardiac lymphatic involvement by metastatic tumor . Cancer 1972;;29:799-808.
17 +
Young JM, Goldman IR:  Tumor metastasis to the heart . Circulation 1954;;9:220-229.
18 +
Javier BV, Yount WJ, Hall TC, et al:  The clinical implications of cardiac metastases from solid tumors: A clinical analysis of 292 cases proved at autopsy . Neoplasma 1967;;14:561-573.
19 +
Bisel HF, Wroblewski F, LaDue JS:  Incidence and clinical manifestations of cardiac metastases . JAMA 1953;;153:712-715.
20 +
Scott RW, Garvin CF:  Tumors of the heart and pericardium . Am Heart J 1939;;17:431-439.
21 +
Skhvatsabaja LV:  Secondary malignant lesions of the heart and pericardium in neoplastic disease . Oncology 1986;;43:103-106.
22 +
Thurber DL, Edwards JE, Achor RWP:  Secondary malignant tumors of the pericardium . Circulation 1962;;26:228-241.
23 +
Goldman BS, Pearson FG:  Malignant pericardial effusion: Review of hospital experience and report of a case successfully treated by talc poudrage . Can J Surg 1965;;8:157-161.
24 +
Adenle AD, Edwards JE:  Clinical and pathologic features of metastatic neoplasms of the pericardium . Chest 1982;;81:166-169.
25 +
Hill GJ, Cohen BI:  Pleural pericardial window for palliation of cardiac tamponade due to cancer . Cancer 1970;;26:81-93.
26 +
Lopez JM, Delgado JL, Tovar E, et al:  Massive pericardial effusion produced by extracardiac malignant neoplasms . Arch Intern Med 1983;;143: 1815-1816.
27 +
Fraser RS, Viloria JB, Wang NS:  Cardiac tamponade as a presentation of extracardiac malignancy . Cancer 1980;;45:1697-1704.
28 +
Theologides A:  Neoplastic cardiac tamponade . Semin Oncol 1978;;5:181-191.
29 +
Krikorian JG, Hancock EW:  Pericardiocentesis . Am J Med 1978;;65:808-814.
30 +
Guberman BA, Fowler NO, Engel PJ, et al:  Cardiac tamponade in medical patients . Circulation 1981;;64:633-640.
31 +
Callaham ML:  Pericardiocentesis in traumatic and nontraumatic cardiac tamponade . Ann Emerg Med 1984;;13:924-945.
32 +
Williams C, Soutter L:  Pericardial tamponade . Arch Intern Med 1956;;94:571-584.
33 +
Cohen JL:  Neoplastic pericarditis . Cardiovasc Clin 1976;;7:257-269.
34 +
McKenna RJ, Ali MK, Ewer MS, et al:  Pleural and pericardial effusions in cancer patients . Curr Probl Cancer 1985;;9:1-44.
35 +
Wong B, Murphy J, Chang CJ, et al:  The risk of pericardiocentesis . Am J Cardiol 1979;;44:1110-1114.
36 +
Bitran JD, Evans R, Brown C:  The management of cardiac tamponade in patients with breast cancer . J Surg Oncol 1984;;27:42-44.

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