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July 6, 1994, Vol 272, No. 1 >
ARTICLE | July 6, 1994

Treatment of Malignant Pericardial Effusion FREE

Paul T. Vaitkus, MD; Howard C. Herrmann, MD; Martin M. LeWinter, MD
[+] Author Affiliations

Reprint requests to Cardiology Unit, 1 McClure, Medical Center Hospital of Vermont, University of Vermont, 111 Colchester Ave, Burlington, VT 05401 (Dr Vaitkus).


JAMA. 1994;272(1):59-64. doi:10.1001/jama.1994.03520010071035
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References

Objective.  —To discuss the diagnosis and treatment of malignant pericardial Objective.—To fusion and focus on quantitating the success and complication rates of the many treatment modalities and updating recent advances in the field.

Data Sources.  —English-language publications were identified by a computerized search (MEDLINE) of these key words: cancer, tumor, malignancy, pericardium, and pericardial effusion. This computerized search was supplemented by a manual search of the bibliographies of original research articles and textbooks.

Study Selection.  —Studies were included if the outcome of patients undergoing treatment for malignant pericardial effusion was reported separately from the outcome of patients with other causes of pericardial effusions. Studies that only reported the combined results of patients with malignant and nonmalignant effusions were excluded.

Data Extraction.  —To determine success rates for the various treatment modalities, we examined freedom from symptomatic recurrence of pericardial effusion requiring reintervention as the key end point. Where appropriate, we also examined procedural mortality rates.

Results.  —Initial relief of symptoms is achieved in most cases with percutaneous pericardiocentesis that, with echocardiographic guidance, can be performed with low morbidity and mortality. In many cases, drainage for several days with an indwelling catheter alleviates the effusion without subsequent recurrence. Systemic antitumor therapy with chemotherapy or radiation therapy is effective in controlling malignant effusions in cases of sensitive tumors such as lymphomas, leukemias, and breast cancer. Local sclerotherapy with tetracycline hydrochloride or bleomycin sulfate is also effective and associated with low morbidity. Sclerotherapy with other agents or radionuclides offers no advantages. Of the several surgical options, subxiphoid pericardiotomy has the advantage of low morbidity and mortality, can often be performed under local anesthesia, and is highly effective in preventing recurrence. Percutaneous balloon pericardiotomy has recently been described. This intervention is performed with local anesthesia, is effective in preventing reaccumulation, and has a low morbidity.

Conclusions.  —Treatment of malignant pericardial effusions must be individualized with consideration given to the patient's condition and tumor type, the success rates and risks of the various modalities, and local availability and expertise.(JAMA. 1994;272:59-64)

REFERENCES

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2 +
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3 +
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8 +
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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.
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Park JS, Rentschler R, Wilbur D.  Surgical management of pericardial effusion in patients with malignancies. Cancer . 1991;;67:76-80.
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Reynolds PM, Byrne MJ.  The treatment of malignant pericardial effusion in carcinoma of the breast. Aust N Z J Med . 1977;;7:169-171.
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Maher ER, Buckman R.  Intrapericardial installation of bleomycin in malignant pericardial effusion. Am Heart J . 1986;;111:613-614.
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Bindi M, Trusso M, Tucci E.  Intracavitary cisplatin in malignant cardiac tamponade. Tumori . 1987;;73:163-165.
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Nelson BE, Rose PG.  Malignant pericardial effusion from squamous cell cancer of the cervix. J Surg Oncol . 1993;;52:203-206.
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Shinde SR, Shaha PB, Shetty PA.  Cardiac tamponade as the only initial feature of malignancy. J Surg Oncol . 1986;;32:96-99.
36 +
Sulkes A, Weshler Z, Kopolovic Y.  Pericardial effusion as first evidence of malignancy in bronchogenic carcinoma. J Surg Oncol . 1982;;20:71-74.
37 +
Fincher RE.  Malignant pericardial effusion as the initial manifestation of malignancy. Am J Med Sci . 1993;;305:106-110.
38 +
Nagamine K, Noda H.  Two cases of primary cardiac lymphoma presenting with pericardial effusion and cardiac tamponade. Jpn Circ J . 1990;;54:1158-1164.
39 +
Cham WC, Freiman AH, Carstens PH, Chu FC.  Radiation therapy of cardiac and pericardial metastases. Radiology . 1975;;114:701-704.
40 +
Rieke JW, Kapp DS.  Successful management of malignant pericardial effusion in metastatic squamous cell carcinoma of the uterine cervix. Gynecol Oncol . 1988;;31:338-351.
41 +
Kaetz HW, Selsky LM.  X-ray therapy in the treatment of cardiac tamponade in chronic myelocytic leukemia: report of a case. Conn Med . 1968;;32:523-524.
42 +
Terry LN, Kligerman MM.  Pericardial and myocardial involvement by lymphomas and leukemias. Cancer . 1970;;25:1003-1008.
43 +
Liedtke AJ, Adams DF, Weber ET, Gorlin R.  Remission of cardiac lymphoma with supervoltage radiation. Am J Med . 1971;;50:816-822.
44 +
Hocken AG.  Malignant pericardial effusion: a case for treatment. BMJ . 1964;;1:164.
45 +
Wei JY, Taylor GJ, Achuff SC.  Recurrent cardiac tamponade and large pericardial effusions. Am J Cardiol . 1978;;42:281-282.
46 +
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47 +
Shepherd FA, Morgan C, Evans WK, Ginsberg JF, Watt D, Murphy K.  Medical management of malignant pericardial effusion by tetracycline sclerosis. Am J Cardiol . 1987;;60:1161-1166.
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van Belle SJ, Volckaert A, Taeymans Y, Spapen H, Block P.  Treatment of malignant pericardial tamponade with sclerosis induced by instillation of bleomycin. Int J Cardiol . 1987;;16:155-160.
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Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Celermajer DS, Boyer MJ, Bailey BP, Tattersall MH.  Pericardiocentesis for symptomatic malignant pericardial effusion. Med J Aust . 1991;;154:19-22.
2 +
Markiewicz W, Borovik R, Ecker S.  Cardiac tamponade in medical patients. Am Heart J . 1986;;111: 1138-1142.
3 +
Buck M, Ingle JN, Giuliani ER, Gordon JR, Therneau TM.  Pericardial effusion in women with breast cancer. Cancer . 1987;;60:263-269.
4 +
Woll PJ, Knight RK, Rubens RD.  Pericardial effusion complicating breast cancer. J R Soc Med . 1987;;80:490-491.
5 +
Guberman BA, Fowler NO, Engel PJ, Gueron M, Allen JM.  Cardiac tamponade in medical patients. Circulation . 1981;;64:633-640.
6 +
Palatianos GM, Thurer RJ, Kaiser GA.  Comparison of effectiveness and safety of operations on the pericardium. Chest . 1985;;88:30-33.
7 +
Miller JI, Mansour KA, Hatcher CR.  Pericardiectomy. Ann Thorac Surg . 1982;;34:40-45.
8 +
Naunhein KS, Kesler KA, Fiore AC, et al.  Pericardial drainage. Eur J Cardiothorac Surg . 1991;; 5:99-104.
9 +
Reitknecht F, Regal AM, Antkowiak JG, Takita H.  Management of cardiac tamponade in patients with malignancy. J Surg Oncol . 1985;;30:19-22.
10 +
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.
11 +
Park JS, Rentschler R, Wilbur D.  Surgical management of pericardial effusion in patients with malignancies. Cancer . 1991;;67:76-80.
12 +
Ghosh SC, Larrieu AJ, Ablaza SG, Grana VP.  Clinical experience with subxyphoid pericardial decompression. Int Surg . 1985;;70:5-7.
13 +
O'Bryan RM, Talley RW, Brennan MJ, San Diego E.  Critical analysis of the control of malignant effusions with radioisotopes. Henry Ford Hosp Med J . 1968;;16:3-13.
14 +
Smith FE, Lane M, Hudgins PT.  Conservative management of malignant pericardial effusion. Cancer . 1974;;33:47-57.
15 +
Martini N, Freiman AH, Watson RC, Hilaris BS.  Intrapericardial instillation of radioactive chromic phosphate in malignant pericardial effusion. AJR Am J Roentgenol . 1977;;128:639-641.
16 +
Thurber DL, Edwards JE, Achor RW.  Secondary malignant tumors of the pericardium. Circulation . 1962;;26:228-241.
17 +
Posner MR, Cohen GI, Skarin AT.  Pericardial disease in patients with cancer. Am J Med . 1981;; 71:407-413.
18 +
Fraser RS, Viloria JB, Wang NS.  Cardiac tamponade as a presentation of extracardiac malignancy. Cancer . 1980;;45:1697-1704.
19 +
Zipf RE, Johnston WW.  The role of cytology in the evaluation of pericardial effusions. Chest . 1972;; 62:593-596.
20 +
Chandraratna PA, Aronow WS.  Detection of pericardial metastases by cross-sectional echocardiography. Circulation . 1981;;63:197-199.
21 +
Edoute Y, Malberger E, Kuten A, Moscovitcz M, Ben-Haim S.  Symptomatic pericardial effusion in lung cancer patients: the role of fluid cytology. J Surg Oncol . 1990;;45:121-123.
22 +
King DT, Nieberg RK.  The use of cytology to evaluate pericardial effusions. Am Clin Lab Sci . 1979;;9:18-23.
23 +
Millaire A, Wurtz A, de Groote P, Saudemont A, Chambon A, Ducloux G.  Malignant pericardial effusions: usefulness of pericardioscopy. Am Heart J . 1992;;124:1030-1034.
24 +
Callahan JA, Seward JB, Nishimura RA, et al.  Two-dimensional echocardiographically guided pericardiocentesis. Am J Cardiol . 1985;;55:476-479.
25 +
Gatenby RA, Hartz WH, Kessler HB.  Percutaneous catheter drainage for malignant pericardial effusion. J Vasc Interv Radiol . 1991;;2:151-155.
26 +
Wong B, Murphy J, Chang CJ, Hassenein K, Dunn M.  The risk of pericardiocentesis. Am J Cardiol . 1979;;44:1110-1114.
27 +
Clarke DP, Cosgrove DO.  Real-time ultrasound scanning in the planning and guidance of pericardiocentesis. Clin Radiol . 1987;;38:119-122.
28 +
Krikorian JG, Hancock EW.  Pericardiocentesis. Am J Med . 1978;;65:808-814.
29 +
Laham RJ, Cohen DJ, Simons M.  Pericardial effusion in patients with cancer. J Am Coll Cardiol . 1994;;21:275A. Abstract 765-4.
30 +
Primrose WR, Clee MD, Johnston RN.  Malignant pericardial effusion managed with vinblastine. Clin Oncol . 1983;;9:67-70.
31 +
Reynolds PM, Byrne MJ.  The treatment of malignant pericardial effusion in carcinoma of the breast. Aust N Z J Med . 1977;;7:169-171.
32 +
Maher ER, Buckman R.  Intrapericardial installation of bleomycin in malignant pericardial effusion. Am Heart J . 1986;;111:613-614.
33 +
Bindi M, Trusso M, Tucci E.  Intracavitary cisplatin in malignant cardiac tamponade. Tumori . 1987;;73:163-165.
34 +
Nelson BE, Rose PG.  Malignant pericardial effusion from squamous cell cancer of the cervix. J Surg Oncol . 1993;;52:203-206.
35 +
Shinde SR, Shaha PB, Shetty PA.  Cardiac tamponade as the only initial feature of malignancy. J Surg Oncol . 1986;;32:96-99.
36 +
Sulkes A, Weshler Z, Kopolovic Y.  Pericardial effusion as first evidence of malignancy in bronchogenic carcinoma. J Surg Oncol . 1982;;20:71-74.
37 +
Fincher RE.  Malignant pericardial effusion as the initial manifestation of malignancy. Am J Med Sci . 1993;;305:106-110.
38 +
Nagamine K, Noda H.  Two cases of primary cardiac lymphoma presenting with pericardial effusion and cardiac tamponade. Jpn Circ J . 1990;;54:1158-1164.
39 +
Cham WC, Freiman AH, Carstens PH, Chu FC.  Radiation therapy of cardiac and pericardial metastases. Radiology . 1975;;114:701-704.
40 +
Rieke JW, Kapp DS.  Successful management of malignant pericardial effusion in metastatic squamous cell carcinoma of the uterine cervix. Gynecol Oncol . 1988;;31:338-351.
41 +
Kaetz HW, Selsky LM.  X-ray therapy in the treatment of cardiac tamponade in chronic myelocytic leukemia: report of a case. Conn Med . 1968;;32:523-524.
42 +
Terry LN, Kligerman MM.  Pericardial and myocardial involvement by lymphomas and leukemias. Cancer . 1970;;25:1003-1008.
43 +
Liedtke AJ, Adams DF, Weber ET, Gorlin R.  Remission of cardiac lymphoma with supervoltage radiation. Am J Med . 1971;;50:816-822.
44 +
Hocken AG.  Malignant pericardial effusion: a case for treatment. BMJ . 1964;;1:164.
45 +
Wei JY, Taylor GJ, Achuff SC.  Recurrent cardiac tamponade and large pericardial effusions. Am J Cardiol . 1978;;42:281-282.
46 +
Rosenthal DS, Braunwald EB.  Hematologicaloncological disorders and heart disease.  In: Braunwald E, ed. Heart Disease . 4th ed. Philadelphia, Pa: WB Saunders Co; 1992;:1742-1766.
47 +
Shepherd FA, Morgan C, Evans WK, Ginsberg JF, Watt D, Murphy K.  Medical management of malignant pericardial effusion by tetracycline sclerosis. Am J Cardiol . 1987;;60:1161-1166.
48 +
Davis S, Rambotti P, Grignani F.  Intrapericardial tetracycline sclerosis in the treatment of malignant pericardial effusion. J Clin Oncol . 1984;; 2:631-636.
49 +
van Belle SJ, Volckaert A, Taeymans Y, Spapen H, Block P.  Treatment of malignant pericardial tamponade with sclerosis induced by instillation of bleomycin. Int J Cardiol . 1987;;16:155-160.
50 +
van der Gaast A, Kok TC, van der Linden NH, Splinter TA.  Intrapericardial instillation of bleomycin in the management of malignant pericardial effusion. Eur J Cancer Clin Oncol . 1989;;25:1505-1506.
51 +
Cormican MC, Nyman CR.  Intrapericardial bleomycin for the management of cardiac tamponade secondary to malignant pericardial effusion. Br Heart J . 1990;;63:61-62.
52 +
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54 +
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55 +
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Compression-Only CPR: Pushing the Science Forward
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