Determinants of Survival After Emergency Intrapericardial Cisplatin Treatment in Cancer Patients with Recurrent Hemodynamic Instability After Pericardiocentesis

Abstract

. Conclusion: Efficacy of rescue intrapericardial chemotherapy with cisplatin is independent of parameters of hemodynamic instability and levels of inflammatory markers in recurrent pericardial effusion.Pericardial diseases constitute an infrequent, although very serious clinical problem among oncological patients. They practically always cause deterioration of the patient's quality of life. The increasing amount of pericardial effusion and the resulting cardiac tamponade is a life-threatening condition which requires urgent diagnostics and treatment.The European Society of Cardiology (ESC) Position Paper related to cardio-oncology summarizes the knowledge on acute and chronic pericarditis as the complication resulting from anticancer treatment: some cytotoxic drugs and radiotherapy (1). Experts indicate that pericardial complications in oncology are usually associated with mediastinal tumors occupying the pericardium. The document does not discuss the issue of pericardial effusion as a potential manifestation of malignant tumor progression. The present state of knowledge concerning malignant pericarditis is based on several retrospective studies and descriptions of small groups of patients. This article presents our own prospective experience related to the treatment of patients suffering from recurrent pericardial effusion and hemodynamic instability in the course of malignant disease.The primary purpose of the observation was the assessment of determinants of overall survival of oncological patients subject to emergency pericardiocentesis and intrapericardial chemotherapy with the use of cisplatin due to recurrent symptomatic pericardial effusion and cardiac tamponade.The detailed aims included the identification of factors which could have direct impact on the overall survival of patients, these included among others: complications of pericardiocentesis and cisplatin administered intrapericardially; signs of inflammatory process: pericardial effusion culture test results, fever, white blood cell count; hemodynamic conditions: baseline level of N-terminal pro-B type natriuretic peptide (NTproBNP), volume and duration of pericardial drainage; interval for recurrence pericardial effusion; possibility of further anticancer treatment. 373

Large Pericardial Effusion—Diagnostic and Therapeutic Options, with a Special Attention to the Role of Prolonged Pericardial Fluid Drainage

“…Moreover, the prolonged drainage in this group of patients enables the examination of several aliquots of pericardial fluid for the presence of neoplastic cells [ 1 , 2 , 5 ]. After confirmation of NPE, the direct intra-pericardial chemotherapy is possible via pericardial drain [ 1 , 2 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

Pericarditis. Clinical Guidelines 2022

“…• Внутриперикардиальное введение цитостатических/склерозирующих (противоопухолевые препараты) средств следует рассмотреть для предотвращения рецидивов у пациентов со злокачественным выпотом [28,231,[253][254][255].…”

“…• Внутриперикардиальное введение #цисплатина** следует рассмотреть при поражении миокарда при раке легкого, внутриперикардиальное введение #тиотепы следует рассмотреть при перикардиальных метастазах при раке молочной железы [231,255,256].…”