Konishi Takanori, Nakamura Rikiya, Yamamoto Naohito, Onai Yasuhide, Okada Toshi, Itami Makiko, Miyazaki Masaru
Division of Breast Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Case Rep Oncol. 2012 Jan;5(1):195-201. doi: 10.1159/000338615. Epub 2012 Apr 25.
With advances in drug treatment of breast cancer, the number of patients experiencing cardiac toxicity or carcinomatous pericarditis is expected to increase. These conditions can cause cardiac tamponade, which is a potentially fatal condition requiring prompt diagnosis and treatment. We experienced 3 breast cancer patients with cardiac tamponade due to carcinomatous pericarditis who survived for prolonged periods after treatment with pericardiocentesis and intrapericardial instillation. The 3 women were 68, 46 and 46 years old, respectively, and receiving treatment for recurrent breast cancer after surgery. They developed dyspnea and cough and were diagnosed with cardiac tamponade by echocardiography. Pericardiocentesis was performed, and cytology of the effusion confirmed the diagnosis of carcinomatous pericarditis. Intrapericardial instillation of cisplatin reduced the cardiac effusion, ameliorating symptoms. The patients died 13, 31 and 14 months later, respectively. In our clinical review of 13 other cases of cardiac tamponade due to breast cancer, 85% achieved local control after the aforementioned local treatments, which were considered to be effective. Although the overall prognosis was poor with a median survival time of only 4 months, some patients were able to survive more than 1 year after local treatment with subsequent systemic therapy.
随着乳腺癌药物治疗的进展，出现心脏毒性或癌性心包炎的患者数量预计将会增加。这些情况可导致心脏压塞，这是一种潜在的致命状况，需要迅速诊断和治疗。我们遇到了3例因癌性心包炎导致心脏压塞的乳腺癌患者，她们在接受心包穿刺术和心包内灌注治疗后存活了较长时间。这3名女性分别为68岁、46岁和46岁，均在术后接受复发性乳腺癌治疗。她们出现呼吸困难和咳嗽症状，经超声心动图诊断为心脏压塞。进行了心包穿刺术，积液的细胞学检查确诊为癌性心包炎。心包内灌注顺铂减少了心包积液，缓解了症状。这些患者分别在13、31和14个月后死亡。在我们对其他13例因乳腺癌导致心脏压塞的病例进行的临床回顾中，85%的患者在上述局部治疗后实现了局部控制，这些治疗被认为是有效的。尽管总体预后较差，中位生存时间仅为4个月，但一些患者在接受局部治疗并随后进行全身治疗后能够存活超过1年。
