肺癌合并心包肿瘤：不同治疗策略对结局的影响。一项多中心研究。

Neoplastic pericardial disease in lung cancer: impact on outcomes of different treatment strategies. A multicenter study.

机构信息

Division of Cardiology, CRO, Centro di Riferimento Oncologico (National Cancer Institute), Aviano, Pordenone, Italy.

出版信息

Lung Cancer. 2011 Jun;72(3):340-7. doi: 10.1016/j.lungcan.2010.10.013. Epub 2010 Nov 30.

DOI:10.1016/j.lungcan.2010.10.013

PMID:21122938

Abstract

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.

摘要

背景

局部（心包内）化疗已被报道对治疗肿瘤性心包疾病有效，但它从未与全身化疗、两者联合、单纯心包引流或硬化治疗进行过比较。

方法

我们分析了 119 例患有肺癌引起的肿瘤性心包炎的患者的临床和超声心动图数据，比较了四种不同治疗策略（心包持续引流/硬化治疗、全身化疗、局部化疗、局部联合全身化疗）在最后一次随访或治疗失败后改变治疗方案时的结局。根据心包疾病的半定量评估，结局分为完全缓解、部分缓解、无反应和疾病进展。

结果

联合治疗组有 37/53 例患者、局部治疗组有 12/22 例患者、全身化疗组有 5/27 例患者、心包引流/硬化治疗组有 4/17 例患者达到完全缓解（p<0.001）。联合治疗组有 51/53 例患者、局部治疗组有 18/22 例患者、全身化疗组有 16/27 例患者达到完全缓解（p<0.001），而心包引流/硬化治疗组只有 5/17 例患者达到完全缓解。联合化疗的生存率明显更好（p<0.001），该亚组中有 12/53 例（23%）患者存活时间超过 1 年。心包内顺铂的总体反应率高于其他药物（98% vs 80%，χ(2)=7.69，p<0.01）。