Colleoni M, Martinelli G, Beretta F, Marone C, Gallino A, Fontana M, Graffeo R, Zampino G, De Pas T, Cipolla G, Martinoni C, Goldhirsch A
Division of Medical Oncology and Service of Cardiology, European Institute of Oncology, Milan, Italy.
J Clin Oncol. 1998 Jul;16(7):2371-6. doi: 10.1200/JCO.1998.16.7.2371.
Malignant pericardial effusion, although highly variable, is an uncommon complication of cancer. It is often associated with symptoms like dyspnea, chest pain, and cough, which may be severe and disabling. We analyzed the results of our current treatment policy to evaluate the effectiveness and tolerance of a new approach for this disorder.
Patients with malignant pericardial effusions were treated with intracavitary thiotepa (15 mg on days 1, 3, and 5) through an indwelling pericardial cannula after extraction of as much pericardial fluid as possible on day 0. Responses were assessed by clinical examination, computed tomographic (CT) scan, and echocardiography before treatment, 1 month after treatment, and every 2 months thereafter. Twenty-three patients with malignant symptomatic pericardial effusion were treated and all were assessable for effectiveness and tolerance of the procedure.
Nine patients with breast cancer, 11 with lung cancer, two with an unknown primary tumor, and one with metastatic melanoma were treated. In all but three patients, systemic medical treatment was started after completion of intracavitary therapy. Nineteen patients responded to treatment (83%; 95% confidence interval, 61% to 95%) with a rapid improvement of symptoms. The median time to pericardial effusion progression was 8.9 months (range, 1 to 26). No significant side effects were registered, except one patient who had transient grade III thrombocytopenia and leukopenia and one patient who had grade I leukopenia.
A short course of intracavitary treatment with thiotepa is highly effective and well tolerated in the treatment of malignant pericardial effusion.
恶性心包积液虽是癌症的一种不常见并发症，但其表现差异很大。它常伴有呼吸困难、胸痛和咳嗽等症状，这些症状可能很严重且使人丧失活动能力。我们分析了当前治疗策略的结果，以评估一种针对该病症的新方法的有效性和耐受性。
恶性心包积液患者在第0天尽可能多地抽出心包积液后，通过留置的心包导管接受腔内噻替派治疗（第1、3和5天各15毫克）。在治疗前、治疗后1个月以及此后每2个月通过临床检查、计算机断层扫描（CT）和超声心动图评估疗效。23例有症状的恶性心包积液患者接受了治疗，所有患者均可评估该治疗方法的有效性和耐受性。
9例乳腺癌患者、11例肺癌患者、2例原发肿瘤不明的患者和1例转移性黑色素瘤患者接受了治疗。除3例患者外，所有患者在腔内治疗完成后均开始了全身药物治疗。19例患者对治疗有反应（83%；95%置信区间，61%至95%），症状迅速改善。心包积液进展的中位时间为8.9个月（范围1至26个月）。除1例出现短暂的III级血小板减少和白细胞减少的患者以及1例出现I级白细胞减少的患者外，未记录到明显的副作用。
腔内噻替派短程治疗在恶性心包积液的治疗中疗效显著且耐受性良好。
