Which Is The Best Approach For Neoplastic Pericardial Effusion? A Retrospective Analysis Of 264 Cases

Purpose: The optimal treatment of neoplastic pericarditis (NP) is still a clinical challenge. Various treatments are used: pericardiocentesis (P), pericardial window (W), systemic chemotherapy (CT), local chemo/radiotherapy, combined systemic and local chemo/radiotherapy. No studies comparing the different approaches are available so far. We will analyse the outcome of a large group of pts who underwent different treatments. Methods: We retrospectively reviewed the data about 264 patients (pts) (164 males) with NP requiring drainage and confirmed by cytology. The tumors were 146 lung and 29 breast carcinomas, 21 lymphomas, 32 other tumors. A neoplastic score including both pericardial effusion and masses was used to assess the severity of pericardial involvement at diagnosis and at the last available follow-up. The outcome was classified as: Complete response (CR) if no effusion or masses were detectable at follow-up; partial response (PR) if the neoplastic score was reduced, stable disease (SD) or progression (PD) if the score was unchanged or worsened. The follow-up was interrupted when a new intervention (drainage, window) was necessary. Results: Pericardiocentesis plus local (P+L) chemo/radiotherapy was performed in 36, plus systemic CT (P+S) in 77, plus combined (P+S+L) therapy in 90; 63 pts had pericardial window plus systemic CT (W+S). A complete or partial response was obtained in 226 pts (85%): 94% of those treated with PW, 91% of those receiving combined CT, 85% of those treated with local CT, and 73% of those receiving systemic CT, (p<0.001). Pericardial drainage had no severe morbidity, vs 14% after surgery. Conclusions: The most effective treatments of neoplastic pericarditis are: Pericardial window associated to systemic CT, pericardial drainage with combined CT. Due to the low morbidity, drainage with local CT are suggested as first line treatment.