Intrapericardial tetracycline sclerosis in the treatment of malignant pericardial effusion: an analysis of thirty-three cases.

Davis, Stephen; Rambotti, P; Grignani, F

doi:10.1200/jco.1984.2.6.631

Cited by 94 publications

(27 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…22 Instillation of tetracyclines as sclerosing agents has been a useful palliative procedure. 23 Instillation of radioactive phosphorus has also been shown to be effective, but the technical expenditure is high. 24 Instillation of different chemotherapeutic agents (especially cisplatin) has also been successfully applied to prevent recurrent effusion.…”

Section: Management Of Malignant Pericardial Effusionmentioning

confidence: 99%

Cardiac metastases

et al. 2008

View full text Add to dashboard Cite

Cardiac metastaseswith induction chemotherapy, with a poor response. Radiotherapy was initiated in order to reduce dysphagia. After 10.8-Gy radiotherapy was stopped because of increasing dyspnea arising from the narrowed left major bronchus (produced by local progression of the tumor), the placement of a bronchial stent was necessitated. At the same time, a second stent was placed in the esophagus to relieve the dysphagia. Palliative radiotherapy was given in fi ve daily fractions of 4 Gy, with marked alleviation of the dysphagia.In December 2006 he developed atypical chest pain. CT of the chest at that time showed regression of the esophageal tumor; but, surprisingly, cardiac metastasis was seen (Fig. 2). On echocardiography left ventricular function appeared normal. A dense hyperechogenic mass was seen in the myocardium, with a small amount of pericardial effusion. Palliative radiotherapy was delivered with anteriorposterior opposing fi elds. Radiation portals encompassed the CM with a margin of 1.5 cm to make sure that, with cardiac motion, the target volume remained in the portal. In order to shorten the treatment period, we prescribed a total dose of 20 Gy, in daily fractions of 4 Gy. Three weeks after the initiation of the palliative radiotherapy his symptoms were alleviated. Unfortunately we could not confi rm this subjective relief with chest CT, because the patient died of aspiration pneumonia 10 weeks after the initiation of the palliative radiotherapy. No autopsy was performed. Discussion and review of the literature EpidemiologyAlthough cardiac metastases (CM) are much more common than primary cardiac tumors, the diagnosis of CM antemortem is seldom made, because more than 90% are clinically silent. About 75% of primary cardiac tumors are benign and 25% are malignant (4% primary malignancy and 96% CM). According to the literature, CM have been found in 1.5%-20% of autopsies of cancer patients and in 0.2%-6.5% of subjects in unselected autopsy series. Abstract We report a case of esophageal cancer with symptomatic metastases to the heart; the patient was treated with short-course radiotherapy with good symptomatic relief. We reviewed the current literature regarding the epidemiology, clinical presentation, diagnostic tools, treatment modalities, and the prognosis of cardiac metastases. In this report we summarize the most recent autopsy studies (published between 1975 and 2007), in which we found an autopsy incidence of cardiac metastases of 2.3% among the general population, while the incidence among autopsies of cancer patients was 7.1%. Therefore, we share the opinion with others that there has been an increase in the incidence of cardiac metastases among cancer patients diagnosed after 1970, in comparison with the reported incidences in older series before 1970 (7.1% vs 3.8%; Kruskal-Wallis rank test; P = 0.039). Special attention was given to the role of radiotherapy in the management of cardiac metastases.

show abstract

Section: Management Of Malignant Pericardial Effusionmentioning

confidence: 99%

Cardiac metastases

et al. 2008

View full text Add to dashboard Cite

show abstract

“…The total number of cases is small and no randomized studies exist to enable exact comparison of the different therapy modalities (table 3). Most experience with intrapericardial application has possibly been gained from using sclerosing, non-anti-neoplastic substances, such as tetracycline [10,11]. Their response rates are high after several applications.…”

Section: Discussionmentioning

confidence: 99%

Intrapericardial Instillation of Mitoxantrone in Palliative Therapy of Malignant Pericardial Effusion

et al. 2003

View full text Add to dashboard Cite

Background: Pericardial effusions occurring with pericardial or myocardial metastases often cause serious complications, necessitating temporary or emergency relief by percutaneous pericardiocentesis. However, this often results in recurrences. For long-term therapy success, the intrapericardial instillation of anti-neoplastic agents is an alternative to surgical methods, which are stressful for the patient. Following our positive experiences with mitoxantrone in the treatment of malignant pleural effusions, we applied this substance for the therapy of malignant pericardial effusions. Patients and Methods: 16 patients with cytologically verified malignant pericardial effusions (8 with bronchial carcinoma, 7 with carcinoma of the breast, 1 with adenocarcinoma of the stomach) received an intrapericardial instillation of mitoxantrone 1–3 ×10–20 mg. Responses were evaluated by echocardiography 30 days after completion of therapy. Results: 12 of 16 patients showed complete remission (no recurrence of a detectable effusion). 3 patients showed a partial remission (recurrence of non-drainage-dependent effusion) (CR + PR = 94%). Within the mean follow-up period of 189 days no recurrences occurred. The rate of side effects was low. Conclusion: Intrapericardial instillation of mitoxantrone is a feasible and effective palliative method for the control of malignant pericardial effusions with little strain on the patients, short duration of hospital stay, cytotoxic characteristics of the substance with a correspondingly high rate of response and low side effects.

show abstract

“…While on one side, some studies quote high association between the two parameters while some other shows lower association. [8][9][10] Likely relation of the underlying condition that creates effusion and mortality associated with pericardial effusion exists. In the present study, in comparison with pericardiocentesis, a lower recurrence rate of was found to be associated with surgical pericardial drainage.…”

Section: Discussionmentioning

confidence: 99%