Cozzi Sergio, Montanara Sergio, Luraschi Annalisa, Fedeli Paola, Buscaglia Paola, Amodei Vincenzina, Fossati Ornella, Gioria Aldo, Garzoli Elisabetta, Ferrari Gianmarco
Struttura Operativa Complessa Oncologia Medica, Ospedale Castelli, Verbania, Italy.
Tumori. 2010 Nov-Dec;96(6):926-9.
Malignant pericardial effusion and cardiac tamponade are known complications of many advanced malignancies such as breast cancer, lung cancer, lymphomas and leukemias. Overall survival is low, due to other metastatic localizations. The present study evaluated the clinical outcome and prognosis in patients with advanced cancer with pericardial effusion.
We studied 7 patients, 4 men and 3 women, with malignant pericardial effusion, affected by breast cancer (2 patients), lung cancer (adenocarcinoma in 3 patients, microcytoma in 1 patient), and B-cell non-Hodgkin lymphoma (1 patient). All patients underwent pericardiocentesis; 3 patients underwent an instillation of thiotepa.
One terminal patient treated with pericardiocentesis died after only a few hours. All the remaining patients experienced immediate symptomatic improvement and no operative complications. At the end of the study period, 2 patients were alive at 59 and 33 months, respectively, and 4 died of disease progression at 1 to 32 months (mean, 10.5).
Pericardiocentesis is an active necessary approach, and intrapericardial treatment with thiotepa was able to reduce pericardial effusion and to prevent its reaccumulation. The standard treatment of malignant effusion and cardiac tamponade has not yet been defined. Physicians should consider the status and the prognosis of each case.
恶性心包积液和心脏压塞是许多晚期恶性肿瘤（如乳腺癌、肺癌、淋巴瘤和白血病）已知的并发症。由于存在其他转移部位，总体生存率较低。本研究评估了晚期癌症合并心包积液患者的临床结局和预后。
我们研究了7例恶性心包积液患者，其中4例男性，3例女性，分别患有乳腺癌（2例）、肺癌（腺癌3例，小细胞癌1例）和B细胞非霍奇金淋巴瘤（1例）。所有患者均接受了心包穿刺术；3例患者接受了噻替派心包腔内注射。
1例接受心包穿刺术治疗的晚期患者在数小时后死亡。其余所有患者症状均立即改善，且无手术并发症。在研究期末，2例患者分别存活59个月和33个月，4例患者在1至32个月（平均10.5个月）死于疾病进展。
心包穿刺术是一种积极必要的治疗方法，心包腔内注射噻替派能够减少心包积液并防止其再次积聚。恶性积液和心脏压塞的标准治疗方法尚未确定。医生应考虑每个病例的病情和预后。
