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Lambert A, Salleron J, Kieffer A, Raymond P, Geoffrois L, Gavoille C. Intrapericardial instillation of bleomycin prevents recurrence of malignant pericardial effusions: Series of 46 cases and comprehensive literature review. Bull Cancer 2020; 107:756-762. [PMID: 32513434 DOI: 10.1016/j.bulcan.2020.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/29/2020] [Accepted: 04/22/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Malignant pericardial effusion is a severe complication of lung and breast cancer. The median survival is less than 4 months and recurrences occurs in about 40% of cases. Systemic chemotherapy and/or local treatments are necessary, even if there is no consensus. METHODS We collected data from patients in our center from 1997 to 2016 who received at least one intrapericardial instillation of bleomycin (60mg). At the same time, we conducted a review of the relevant literature on the subject. RESULTS We included 46 patients in the analysis. Median survival was 2.6 months [95% CI: 1.7; 4.7]. Overall survival was 49% [33%; 63%] at 3 months and 28% [15%; 42%] at 6 months. In the lung cancer subgroup, overall survival was 18% [3%; 44%] at 3 months. In the breast cancer subgroup, overall survival was 73% [44%; 89%] at 3 months and 46% [21%; 69%] at 6 months. DISCUSSION The best response rates in the literature are obtained with local instillation of bleomycin or cisplatin. Malignant pericardial effusions in breast cancer patients had a better prognosis. This is certainly related to the prognosis of the underlying disease. We have not found an increase in overall survival with intrapericardial chemotherapy injections, but preventing recurrence of malignant pericardial effusions is a benefit in itself, thus avoiding a lethal complication.
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Affiliation(s)
- Aurélien Lambert
- Institut de cancérologie de Lorraine, Department of Medical Oncology, Vandœuvre-lès-Nancy, France.
| | - Julia Salleron
- Institut de Cancérologie de Lorraine, Biostatistics Unit, Vandœuvre-lès-Nancy, France
| | - Anne Kieffer
- Institut de cancérologie de Lorraine, Department of Medical Oncology, Vandœuvre-lès-Nancy, France
| | - Perrine Raymond
- Institut de cancérologie de Lorraine, Department of Medical Oncology, Vandœuvre-lès-Nancy, France
| | - Lionel Geoffrois
- Institut de cancérologie de Lorraine, Department of Medical Oncology, Vandœuvre-lès-Nancy, France
| | - Céline Gavoille
- Institut de cancérologie de Lorraine, Department of Medical Oncology, Vandœuvre-lès-Nancy, France
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Cytopathology of pericardial effusions. Herz 2017; 43:543-547. [DOI: 10.1007/s00059-017-4596-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/15/2017] [Accepted: 06/17/2017] [Indexed: 11/27/2022]
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Shenkman Z, Rockoff MA, Eldredge EA, Korf BR, Black PML, Soriano SG. Anaesthetic management of children with tuberous sclerosis. Paediatr Anaesth 2002; 12:700-4. [PMID: 12472707 DOI: 10.1046/j.1460-9592.2002.00917.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Tuberous sclerosis (TS) is a hamartomatous disease that usually presents with cutaneous and intracranial lesions, but can also affect other organ systems. METHODS In this report, we retrospectively reviewed the perioperative course of 24 children with TS who had medically intractable seizures as the primary disease process. RESULTS Cardiac rhabdomyoma was detected in 11 of 18 patients who had a cardiac evaluation, and coexisting congenital heart defects were diagnosed in six. Ten of 17 patients who had a renal evaluation were diagnosed with renal TS, presenting with azotaemia in one and hypertension in four. The major perioperative complications in the 52 anaesthetics, included death (a neonate after cardiac rhabdomyoma resection), seizures (five patients) and bradyarrhythmias (two patients). CONCLUSIONS Patients with TS and neurological disorders frequently have coexisting cardiac and renal disease as well. Patients with TS should be evaluated for these organ specific disorders prior to surgery.
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Affiliation(s)
- Ze'ev Shenkman
- Department of Anaesthesia, Children's Hospital, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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Abstract
Malignancies rarely arise from the pericardium. Mesothelioma, the most common of these, is usually unresectable and almost always incurable. Malignancies may secondarily involve the pericardium by direct extension. Carcinoma of the lung and malignant thymoma with limited direct invasion of the pericardium both can undergo complete and potentially curative resections, but adjuvant therapy is usually indicated. More frequently, malignancies involve the pericardium by a process of retrograde lymphangitic spread or hematogenous dissemination. These patients present with a symptomatic pericardial effusion and occasionally pericardial tamponade. Subxiphoid pericardiostomy and drainage is a safe procedure that provides effective and durable symptomatic relief in these terminally ill patients. More aggressive open procedures should be reserved for loculated or recurrent pericardial effusions.
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Affiliation(s)
- W H Warren
- Department of Cardiovascular-Thoracic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA
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Abstract
Surgical resection is usually the only form of curative therapy available for primary cardiac neoplasms. Benign tumors can often be completely removed with few complications and a low mortality rate, but complete resection is possible for fewer than half of primary malignant tumors. Radiation therapy plays an adjunct and palliative role in treatment. The outcome of chemotherapy, the dominant treatment method, is poor. Sarcomas are inherently chemoresistant and show a response rate of less than 50%. Lymphomas present late and respond poorly. Cardiectomy and cardiac transplantation may cure unresectable benign cardiac tumors or, rarely, malignant ones.
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Abstract
We reviewed 22 cases of primary pediatric cardiac tumors followed at our institution from January 1981 through November 1997, analyzing them by subtype, age and manner of presentation, location, associated findings, interventions, and clinical course. Rhabdomyomas were the most common (11), followed by intrapericardial teratomas (2), myxomas (1), fibromas (1), hemangiomas (1), mesotheliomas (1), and rhabdomyosarcomas (1), with 4 undetermined tumors. The majority (77%) of tumors were diagnosed before the age of one year, including six prenatally. The most common presentations were murmurs (5), arrhythmias (5), and abnormal screening fetal ultrasound examinations (4). Tumors were located most frequently in the right ventricle (13) and left ventricle (7), with multiple tumors being present in 10 cases. Eight patients (36%) had associated arrhythmias or conduction abnormalities, and of the 11 patients with rhabdomyomas, tuberous sclerosis was diagnosed in 8. Eight patients underwent cardiac catheterization, including two for electrophysiologic study with radiofrequency ablation, and seven patients had complete or partial tumor resection. The follow-up period ranged from 2 months to 15 years, and there were 3 tumor-related deaths. Therefore, despite the benign histology of most primary pediatric cardiac tumors, there may be significant associated morbidity and occasional mortality. As echocardiographic techniques such as fetal ultrasonography have continued to improve, however, these cardiac tumors have increasingly been detected early before significant symptoms develop.
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Affiliation(s)
- D Sallee
- Department of Pediatrics, Rainbow Babies and Childrens Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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Calzas J, Lianes P, Cortés-Funes H. [Heart pathology of extracardiac origin. VII. Heart and neoplasms]. Rev Esp Cardiol 1998; 51:314-31. [PMID: 9608805 DOI: 10.1016/s0300-8932(98)74751-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiac alterations of neoplastic diseases can be due to direct invasion produced by primary cardiac tumors or more frequently secondary to local compression of vascular structures by extracardiac neoplasms, such as superior vena cava syndrome. One of the most important alterations is the cardiotoxicity of anticancer treatments, either chemotherapy drugs or radiotherapy techniques. These treatments cause acute and/or chronic cardiotoxicity that the oncologist and the cardiologist must be aware of. For instance, 4.5% to 7% of patients that have been treated with anthracyclines may suffer cardiac failure in their lifetime. The pathogenesis is still not clear. There is currently a lot of research on cardioprotectors, but nowadays the only one approved by the FDA is dexrazoxane, which is used on breast cancer patients treated with adriamycin.
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Affiliation(s)
- J Calzas
- Servicio de Oncología Médica, Hospital Universitario 12 de Octubre, Madrid
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9
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Ripamonti C, Fulfaro F, Bruera E. Dyspnoea in patients with advanced cancer: incidence, causes and treatments. Cancer Treat Rev 1998; 24:69-80. [PMID: 9606369 DOI: 10.1016/s0305-7372(98)90072-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- C Ripamonti
- Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy
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Khoo V, Ngan S, Guiney M, Lim-Joon D. Acute vascular embolus resulting from metastatic endocardial involvement with synovial sarcoma: report of a case and review of the literature. AUSTRALASIAN RADIOLOGY 1997; 41:49-52. [PMID: 9125069 DOI: 10.1111/j.1440-1673.1997.tb00469.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A rare case of metastatic soft tissue sarcoma (STS) involving the endocardium of the left ventricle of the heart is described. A 57-year-old man with a previously resected synovial sarcoma of the anterior abdominal wall presented 5 years later with an acute ischaemic arm resulting from tumour embolus. The treatment and outcome of the patient are outlined. Metastatic STS cardiac involvement and management of this complication are reviewed.
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Affiliation(s)
- V Khoo
- Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
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Hicks KA, Kovach JA, Frishberg DP, Wiley TM, Gurczak PB, Vernalis MN. Echocardiographic evaluation of papillary fibroelastoma: a case report and review of the literature. J Am Soc Echocardiogr 1996; 9:353-60. [PMID: 8736022 DOI: 10.1016/s0894-7317(96)90152-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Papillary fibroelastomas comprise approximately 7.9% of benign primary cardiac tumors. Although papillary fibroelastomas were at first discovered incidentally at autopsy or during heart surgery, these tumors are increasingly being identified by echocardiography. This article reviews those papillary fibroelastomas detected by transthoracic or transesophageal echocardiography and discusses the echocardiographic features of these tumors, associated symptoms, and management. Echocardiography is important in influencing management decisions regarding excision, valve replacement, and valve repair.
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Affiliation(s)
- K A Hicks
- Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307, USA
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ZEPPELLINI ROBERTO, GHENO GIUSEPPE, CUCCHINI FRANCESCO. Misleading Echo-Doppler Findings in Prolapsing Right Atrial Myxoma. Echocardiography 1995. [DOI: 10.1111/j.1540-8175.1995.tb00525.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Shyu KG, Chen JJ, Cheng JJ, Hwang JJ, Kuan P, Lien WP. Comparison of transthoracic and transesophageal echocardiography in the diagnosis of intracardiac tumors in adults. JOURNAL OF CLINICAL ULTRASOUND : JCU 1994; 22:381-389. [PMID: 8071456 DOI: 10.1002/jcu.1870220605] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
To compare transthoracic and transesophageal echocardiography in the diagnosis of intracardiac tumors, 17 patients (8 men and 9 women, aged 19 years to 67 years) whose intracardiac tumors were detected by echocardiography were studied in a 4-year period. Of these, 14 patients underwent cardiac surgery and 13 were proved to have tumors. There were 4 false-positive and 2 false-negative diagnoses by transthoracic echocardiography, but only one false-positive and no false-negative diagnosis by transesophageal echocardiography. The stalk of a myxoma was detected clearly in 5 of 11 patients by transthoracic echocardiography, whereas in 10 of 11 it was detected by transesophageal echocardiography. The detailed morphologic characteristics of the tumor, such as contour of the tumor, and the presence of cysts and calcification in the tumor, were seen more clearly with transesophageal echocardiography than with transthoracic echocardiography.
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Affiliation(s)
- K G Shyu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Republic of China
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Mouratidou DK, Bishiniotis TS, Andreadis CG, Litos A. Cardiac tamponade due to neoplastic pericarditis in a patient with ovarian yolk sac tumor. Ann Oncol 1993; 4:896-7. [PMID: 8117613 DOI: 10.1093/oxfordjournals.annonc.a058403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Thomas CR, Johnson GW, Stoddard MF, Clifford S. Primary malignant cardiac tumors: update 1992. MEDICAL AND PEDIATRIC ONCOLOGY 1992; 20:519-31. [PMID: 1435522 DOI: 10.1002/mpo.2950200607] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C R Thomas
- Division of Oncology, University of Washington School of Medicine, Seattle
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Seidal T, Wandt B, Lundin SE. Primary chondroblastic osteogenic sarcoma of the left atrium. Case report. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1992; 26:233-6. [PMID: 1287840 DOI: 10.3109/14017439209099084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A case of chondroblastic osteogenic sarcoma of the left atrium is presented. The malignant nature of the tumour was not revealed until surgery. It was considered to be nonresectable. At autopsy the tumour was found to be confined to the atrial septum. The possibility of preoperatively establishing the diagnosis and determining the extent of the tumour is discussed.
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Affiliation(s)
- T Seidal
- Department of Pathology, Central Hospital, Karlstad, Sweden
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Cercato MC, La Ferla G, Pericoli N, Fedele Scinto A, Sacchi I, Cognetti F. Cardiac tamponade as the initial manifestation of extracardiac malignancy. Eur J Cancer 1991; 27:670-1. [PMID: 1828983 DOI: 10.1016/0277-5379(91)90246-a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
Respiratory symptoms are a common cause of distress in patients with advanced cancer. Optimal palliative therapy requires careful assessment and the appropriate use of symptomatic measures in conjunction with specific antitumor treatments. The etiology and management of the three major respiratory symptoms, dyspnea, cough and hemoptysis, are described. The indications for antitumor treatments and surgical procedures are briefly outlined, and symptomatic treatments, including drug and nondrug measures, are discussed in detail.
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van der Gaast A, Kok TC, van der Linden NH, Splinter TA. Intrapericardial instillation of bleomycin in the management of malignant pericardial effusion. EUROPEAN JOURNAL OF CANCER & CLINICAL ONCOLOGY 1989; 25:1505-6. [PMID: 2480244 DOI: 10.1016/0277-5379(89)90112-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- A van der Gaast
- Department of Medical Oncology, University Hospital, Rotterdam-Dijkzigt, The Netherlands
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