1
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Li H, Wang C, Guo C. Post-marketing safety of lorlatinib: a real-world study based on the FDA adverse event reporting system. Front Pharmacol 2024; 15:1385036. [PMID: 38903993 PMCID: PMC11188337 DOI: 10.3389/fphar.2024.1385036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Background Lorlatinib displays marked systemic and intracranial efficacy against anaplastic lymphoma kinase (ALK) positive non-small cell lung cancer (NSCLC). We aimed to establish the safety profile of lorlatinib based on the Food and Drug Administration Adverse Event Reporting System (FAERS). Methods Reports from the FAERS between 2019 and 2023 were collected to conduct the disproportionality analysis. Reporting odds ratio (ROR) was employed to detect the potential adverse events (AEs) related to lorlatinib. The clinical characteristics, age and gender differences, time to onset of AEs were also investigated. Results A total of 2,941 AE reports were found to be associated with lorlatinib among the 8,818,870 AE reports obtained from the FAERS database. 167 lorlatinib-related AE signals were identified. The frequently reported AEs including hypercholesterolemia, oedema, and cognitive disorder were in line with those observed in clinical trials and drug instruction. However, AEs such as interstitial lung disease and AV block indicated in the drug label require further evaluation. More attention should be paid to the new potential unexpected AEs including pulmonary arterial hypertension and radiation necrosis. Furthermore, we examined the specific high-risk AEs of different ages and genders. In addition, majority of AEs occurred within the first 2 months after lorlatinib initiation with a median onset time of 51 days. Conclusion Our study provides valuable insight into the post-marketing safety profile of lorlatinib, which can potentially benefit the rational and safe administration of lorlatinib in the clinic. Further prospective studies are needed to validate the associations between lorlatinib and the identified AEs.
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Affiliation(s)
- Huqun Li
- Department of Pharmacy, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chongshu Wang
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cuilian Guo
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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2
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Li H, Han D, Zhang L, Feng X, Li H, Yang F, Song L, Li X. PD-1/L1 inhibitors may increase the risk of pericardial disease in non-small-cell lung cancer patients: a meta-analysis and systematic review. Immunotherapy 2022; 14:577-592. [PMID: 35373580 DOI: 10.2217/imt-2021-0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: The advent of PD-1/L1 inhibitors has changed the landscape for patients with non-small-cell lung cancer (NSCLC). Meanwhile, the adverse events of PD-1/L1 inhibitors have been focused. Methods: The Cochrane Central Register of Controlled Trials, PubMed and Embase databases and ClinicalTrials.gov were searched from inception to February 2021. Results: 18 studies involving 11,394 patients with NSCLC were included. PD-1/L1 inhibitor monotherapy was associated (relative risk, 95% confidence interval) with an increased risk of pericardial effusion (2.72 [1.45-5.12]; p = 0.002) and cardiac tamponade (2.76 [1.15-6.62]; p = 0.023), whereas PD-1/L1 inhibitors combined with chemotherapy did not increase the risk of pericardial effusion and cardiac tamponade (3.08 [0.93-10.21]; p = 0.066 and 3.27 [0.37-28.94]; p = 0.288, respectively). Conclusion: For patients with NSCLC, treatment with PD-1/L1 inhibitor monotherapy increases the risk of pericardial effusion and cardiac tamponade, but PD-1/L1 inhibitors combined with chemotherapy do not.
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Affiliation(s)
- Honglin Li
- First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Deting Han
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Lei Zhang
- First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xiaoteng Feng
- Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huijie Li
- Department of Oncology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Feiran Yang
- First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Lucheng Song
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Xiurong Li
- Department of Oncology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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3
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Liu Y, Chen C, Rong C, He X, Chen L. Anaplastic Lymphoma Kinase Tyrosine Kinase Inhibitor-Associated Cardiotoxicity: A Recent Five-Year Pharmacovigilance Study. Front Pharmacol 2022; 13:858279. [PMID: 35370632 PMCID: PMC8968911 DOI: 10.3389/fphar.2022.858279] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/25/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Clinical trials frequently reported anaplastic lymphoma kinase tyrosine kinase inhibitors (ALK-TKIs) associated with cardiac adverse drug events (AEs) but minimal postmarketing data. We aimed to research real-world cardiac disorders associated with ALK-TKIs based on the Food and Drug Administration Adverse Event Reporting System (FAERS). Methods: Extract reports from the FAERS from the first quarter of 2016 to the second quarter of 2021 were obtained. Data mining of cardiac disorders associated with ALK-TKIs was carried out using disproportionality analysis to determine the clinical characteristics of AEs. Results: In total, 605 cases were screened out. These events were found to be more prevalent in patients ≥45 years (50.74%) and women (50.74%). The onset time of cardiac disorders was variable and concentrated within 2 months, with a median time of 33 days. The outcomes tended to be poor, with 20.93% fatality proportion. Cardiac arrhythmia was a common adverse event of ALK-TKIs, especially bradycardia. Crizotinib and lorlatinib showed positive signals in cardiac disorders, especially in heart failure, and brigatinib presented no signals. The study also found that myocarditis caused by ceritinib and cardiomyopathy caused by lorlatinib may be potential new adverse drug reactions. Conclusion: ALK-TKIs were reported more frequently in cardiotoxicity than other drugs and could often manifest earlier. We also found potential new AE signals in specific drugs and need more clinical studies to confirm. Our study helps fill the safety information of ALK-TKIs in the heart and provides directions for further research.
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Affiliation(s)
- Yihan Liu
- Department of Pharmacy, West China Second Hospital, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.,Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Chen
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China.,West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Chencheng Rong
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Xucheng He
- Department of Pharmacy, Pengzhou Second People's Hospital, Chengdu, China
| | - Li Chen
- Department of Pharmacy, West China Second Hospital, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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4
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Rahman AU, Folaranmi O, Chan V, Chaudary A. Anaplastic Lymphoma Kinase-Positive Primary Lung Adenocarcinoma Presenting With Pericardial Effusion and Tamponade in a COVID-19 Patient: A Case Report. Cureus 2021; 13:e19127. [PMID: 34868767 PMCID: PMC8627680 DOI: 10.7759/cureus.19127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Primary lung cancer usually presents in older adults with a smoking history. However, there is an estimated incidence of 15-20% among men who have never smoked. The diagnosis of lung malignancy can often be incidental. Moreover, cardiac tamponade can be an initial presentation of malignancy, especially lung cancer, as these are the most common tumors that involve the pericardium. Here, we present a 54-year-old male with no known medical history presented with dyspnea on exertion. He was found to have a large pericardial effusion with tamponade physiology on a bedside echocardiogram. He was also found to have bilateral deep vein thrombosis and pulmonary embolism on admission. The patient underwent an emergent pericardiocentesis due to hemodynamic compromise, and pericardial fluid cytology suggested adenocarcinoma with lung primary. Subsequently, gene testing revealed anaplastic lymphoma kinase-positive adenocarcinoma of the lung. The patient was discharged home with close oncology follow-up. It is imperative to recognize malignant pericardial effusion as one of the causes of dyspnea. Emergent pericardiocentesis may be needed in case of hemodynamic compromise and tenuous clinical status.
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Affiliation(s)
| | | | - Vernon Chan
- Internal Medicine, WellSpan York Hospital, York, USA
| | - Amna Chaudary
- Internal Medicine, WellSpan York Hospital, York, USA
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5
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Otoshi R, Sekine A, Okudela K, Asaoka M, Sato Y, Ikeda S, Baba T, Komatsu S, Hagiwara E, Ogura T. Small-cell lung carcinoma transformation of lung adenocarcinoma diagnosed by pericardial effusion: A case report. Mol Clin Oncol 2020; 13:129-132. [PMID: 32714535 PMCID: PMC7366234 DOI: 10.3892/mco.2020.2059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 04/30/2020] [Indexed: 01/05/2023] Open
Abstract
The present report describes a case of a 68-year-old male patient with epidermal growth factor receptor (EGFR)-mutant non-small cell lung carcinoma (NSCLC). After cytotoxic chemotherapy of three regimens following 22 months of treatment with EGFR-tyrosine kinase inhibitors (EGFR-TKIs), including osimertinib, the patient underwent S-1 treatment. Despite a decrease in carcinoembryonic antigen 1 month after initiating S-1 treatment, the patient developed cardiac tamponade. The evaluation of pericardial effusion confirmed small-cell lung carcinoma (SCLC) transformation. Subsequently, a combination therapy of carboplatin and etoposide was administered, which led to a marked improvement in imaging. In patients with NSCLC who develop pericardial effusion after long-term EGFR-TKI therapy, including osimertinib treatment, it is important to investigate whether SCLC transformation occurs or not as a treatable entity.
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Affiliation(s)
- Ryota Otoshi
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa 236-0051, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa 236-0051, Japan
| | - Koji Okudela
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0027, Japan
| | - Masato Asaoka
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa 236-0051, Japan
| | - Yozo Sato
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa 236-0051, Japan
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa 236-0051, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa 236-0051, Japan
| | - Shigeru Komatsu
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa 236-0051, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa 236-0051, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa 236-0051, Japan
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6
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Prognostic factors and nomogram for cancer-specific death in non small cell lung cancer with malignant pericardial effusion. PLoS One 2019; 14:e0217007. [PMID: 31095610 PMCID: PMC6521987 DOI: 10.1371/journal.pone.0217007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/02/2019] [Indexed: 01/21/2023] Open
Abstract
Background The prognosis of lung cancer with malignant pericardial effusion is very terrible owing to the impact of cardiac tamponade. The aim of our study seeks to identify prognostic factors and establish a prognostic nomogram of non small cell lung cancer (NSCLC) with malignant pericardial effusion. Methods NSCLC patients with malignant pericardial effusion between 2010 and 2014 are searched from SEER database.Cancer-specific death of these patients are analyzed through the Kaplan–Meier method, Cox proportional hazard model and competing risk model. Prognostic nomogram of cancer-specific death is performed and validated with concordance index (C-index), calibration plots and internal validation population. Propensity score matching is used to evaluate whether chemotherapy affected the survival of study population. Results 696 eligible NSCLC patients are involved in the study population, with 22.7% of 1-year survival rate and 8.9% of 2-year survival rate. Laterality, AJCC N, AJCC T, and chemotherapy are regarded as independent prognostic factors of cancer-specific death in the Cox proportional hazards model and competing risk model. The C-index of established nomogram is 0.703(95%CI:0.68–0.73) for cancer-specific death in the study population with acceptable calibration, which is significantly higher than classical TNM stage(C-index = 0.56, 95%CI:0.52–0.60). After 1:1 propensity score matching, chemotherapy potentially reduces the risk of cancer-specific death (HR = 0.42 95%CI: 0.31–0.58) of NSCLC with pericardial effusion. Conclusions NSCLC with malignant pericardial effusion harbors low overall survival. One prognostic nomogram based on laterality, AJCC N, AJCC T and chemotherapy is developed for cancer-specific death to predict 1-year and 2-year survival rate with good performance.
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7
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Di Liso E, Menichetti A, Dieci MV, Ghiotto C, Banzato A, Bianchi A, Pintacuda G, Padovan M, Nappo F, Cumerlato E, Miglietta F, Mioranza E, Zago G, Corti L, Guarneri V, Conte P. Neoplastic Pericardial Effusion: A Monocentric Retrospective Study. J Palliat Med 2019; 22:691-695. [PMID: 30888908 DOI: 10.1089/jpm.2018.0491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Neoplastic pericardial effusion (NPE) is a life-threatening condition that can worsen clinical outcome in cancer patients. The optimal management of NPE has yet to be defined because randomized studies are lacking. Objective: We report a retrospective monoinstitutional experience describing characteristics, management and prognostic factors in NPE patients. Design: We reviewed clinical, pathological, and echocardiographic features, therapeutic strategies, and outcome in NPE patients referred to our institute from August 2011 to December 2017. Measurements: Twenty-nine patients with NPE from solid tumors have been identified: 21 lung, 5 breast, and 3 other cancer patients. Results: Median age was 62 years. Most of the patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2 (69%) and a symptomatic NPE (69%). In 52% of patients NPE was detected at first diagnosis of metastatic disease, and in 20% of patients pericardium was the only site of metastases. Most of the patients (62%) received systemic therapy, 28% received combined locoregional and systemic therapy, and 10% received locoregional therapy alone. Median overall survival (OS) from NPE diagnosis was 3.9 months. Patients with PS ≥2 had worse OS than patients with better PS <2 (hazard ratio [HR] 3.56, IC 95% 1.19-10.65, p 0.02). Older age, extrapericardial disease, and NPE at progression showed a trend of association with worse OS. Patients treated with locoregional therapy alone showed the shortest median OS (p 0.05). Conclusions: NPE is related to dismal prognosis. Poor PS significantly worsens survival and influences therapeutic approaches. Randomized studies are required to investigate prognostic factors and appropriate clinical management for patients with NPE.
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Affiliation(s)
- Elisabetta Di Liso
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Alice Menichetti
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Maria Vittoria Dieci
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy.,2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Cristina Ghiotto
- 2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Alberto Banzato
- 3 Cardiology Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | | | - Marta Padovan
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Floriana Nappo
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Enrico Cumerlato
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Federica Miglietta
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Eleonora Mioranza
- 2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Giulia Zago
- 2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Luigi Corti
- 5 Radiotherapy Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Valentina Guarneri
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy.,2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Pierfranco Conte
- 1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy.,2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
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8
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Martínez-Girón R, Pantanowitz L, Martínez-Torre S, Pantanowitz J. Sudden cardiac death due to primary malignant pericardial mesothelioma: Brief report and literature review. Respir Med Case Rep 2019; 26:185-188. [PMID: 30705816 PMCID: PMC6349302 DOI: 10.1016/j.rmcr.2019.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 01/11/2019] [Indexed: 11/17/2022] Open
Abstract
Sudden cardiac death is an unexpected clinical condition that typically occurs due to a cardiac cause, generally within 1 h of symptom onset, in people with known or unknown cardiac disease. Primary malignant pericardial mesothelioma, as a cause of sudden death, is an uncommon consequence of a rare disease. Herein, we present a case of cardiac tamponade due to a primary pericardial mesothelioma. Cytological, histopathology and gross post-mortem findings, in a previously asymptomatic 46-old-year man, are reported. The medical literature regarding this topic is also reviewed.
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Affiliation(s)
- Rafael Martínez-Girón
- INCLÍNICA Foundation for Clinical, Pneumological and Carcinogenic Research, Calvo Sotelo, 16, 33007, Oviedo, Spain
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, USA
| | - Santiago Martínez-Torre
- Departament of Family and Community Medicine, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain
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9
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Darocha S, Wilk M, Walaszkowska-Czyż A, Kępski J, Mańczak R, Kurzyna M, Torbicki A, Szmit S. Determinants of Survival After Emergency Intrapericardial Cisplatin Treatment in Cancer Patients with Recurrent Hemodynamic Instability After Pericardiocentesis. ACTA ACUST UNITED AC 2018; 32:373-379. [PMID: 29475923 DOI: 10.21873/invivo.11248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 12/17/2017] [Accepted: 12/21/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pericardial effusion is associated with high mortality in oncology. The etiology of infectious pericarditis and iatrogenic effects of previous radio-/chemotherapy may be always suspected, especially when a subsequent episode is observed. PATIENTS AND METHODS The study included 17 hemodynamically-unstable patients with cancer due to recurrent pericardial bloody effusion after previous pericardiocentesis and analyzed survival determinants after intrapericardial chemotherapy with cisplatin. RESULTS The mortality rate was not significantly associated with the level of N-terminal pro-B type natriuretic peptide, low hemoglobin (<12 g/dl), elevated white blood cell account (>104/μl), large volume (>1500 ml) and long duration (>8 days) of pericardial drainage, cardiac arrhythmias, positive culture test results nor fever occurring during cisplatin administration. Subsequent systemic anticancer therapy was the strongest factor determining a longer survival (hazard ratio(HR)=0.31, 95% confidence interval(CI)=0.11-0.9; p=0.03). CONCLUSION Efficacy of rescue intrapericardial chemotherapy with cisplatin is independent of parameters of hemodynamic instability and levels of inflammatory markers in recurrent pericardial effusion.
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Affiliation(s)
- Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Michał Wilk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland.,Department of Clinical Oncology, European Health Centre, Otwock, Poland
| | | | - Jarosław Kępski
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Rafał Mańczak
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
| | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
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10
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Szturmowicz M, Tomkowski W, Fijalkowska A, Kupis W, Cieślik A, Demkow U, Langfort R, Wiechecka A, Orlowski T, Torbicki A. Diagnostic Utility of Cyfra 21-1 and Cea Assays in Pericardial Fluid for the Recognition of Neoplastic Pericarditis. Int J Biol Markers 2018. [DOI: 10.1177/172460080502000107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A positive cytology result in pericardial fluid is the gold standard for recognition of malignant pericardial effusion. Unfortunately, in 30–50% of patients with malignant pericardial effusion cytological examination of the pericardial fluid is negative. Tumor marker assessment in pericardial fluid may help to recognize malignant pericardial effusion. The aim of our study was to estimate the value of CYFRA 21-1 and CEA measurement in pericardial fluid for the recognition of malignant pericardial effusion. To our knowledge this is the first study on CYFRA 21-1 assessment in pericardial effusion. The examined group consisted of 50 patients with malignant pericardial effusion and 34 patients with non-malignant pericardial effusion. Median CEA concentrations in malignant pericardial effusion and non-malignant pericardial effusion were 80 ng/mL (0–317) and 0.5 ng/mL (0–18.4), respectively (p<0.001). Median CYFRA 21-1 concentrations in malignant pericardial effusion and non-malignant pericardial effusion were 260 ng/mL (5.3–10080) and 22.4 ng/mL (1.87–317.6), respectively (p<0.001). The optimal cutoff value for CYFRA 21-1 in pericardial effusion was 100 ng/mL. CYFRA 21-1 >100 ng/mL or CEA >5 ng/mL were found in 14/15 patients with malignant pericardial effusion and negative pericardial fluid cytology. We therefore strongly recommend the use of CYFRA 21-1 and/or CEA in addition to pericardial fluid cytology for the recognition of malignant pericardial effusion.
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Affiliation(s)
- M. Szturmowicz
- Department of Internal Medicine National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - W. Tomkowski
- Cardiopulmonary Intensive Care Division National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - A. Fijalkowska
- Department of Internal Medicine National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - W. Kupis
- Department of Thoracic Surgery National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - A. Cieślik
- Department of Internal Medicine National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - U. Demkow
- Department of Clinical Biochemistry National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - R. Langfort
- Department of Pathology National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - A. Wiechecka
- Department of Radiology National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - T. Orlowski
- Department of Thoracic Surgery National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
| | - A. Torbicki
- Department of Internal Medicine National Institute of Tuberculosis and Lung Diseases, Warsaw - Poland
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11
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He B, Yang Z, Zhao P, Li YJ, Wang JG. Cytopathologic analysis of pericardial effusions in 116 cases: Implications for poor prognosis in lung cancer patients with positive interpretations. Diagn Cytopathol 2017; 45:287-293. [PMID: 28139896 DOI: 10.1002/dc.23671] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/09/2016] [Accepted: 01/12/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Bing He
- Department of Pathology; School of Basic Medicine, Qingdao University; Qingdao 266071 China
- Department of Pathology; The Affiliated Hospital of Qingdao University; Qingdao 266003 China
| | - Zhen Yang
- Department of Pathology; The Affiliated Hospital of Qingdao University; Qingdao 266003 China
| | - Peng Zhao
- Department of Pathology; The Affiliated Hospital of Qingdao University; Qingdao 266003 China
| | - Yu-Jun Li
- Department of Pathology; The Affiliated Hospital of Qingdao University; Qingdao 266003 China
| | - Ji-Gang Wang
- Department of Pathology; The Affiliated Hospital of Qingdao University; Qingdao 266003 China
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12
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Kalogeraki A, Lazopoulos G, Papadakis GZ, Tamiolakis D, Karvela-Kalogeraki I, Karvelas-Kalogerakis M, Segredakis J, Chalkiadakis GE. Cytology of Pericardial Effusion due to Malignancy. ACTA ACUST UNITED AC 2017; 54:179-183. [PMID: 27658166 DOI: 10.1515/rjim-2016-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Malignant pericardial effusion occurs in one tenth of all cancers. It is a very serious disorder that is mainly a secondary process due to metastasis because primary neoplasms of the pericardium such as mesotheliomas, sarcomas being exceedingly rare [corrected]. Pericardial effusion specimens are uncommon and to the best of our knowledge the current study is the largest systematic evaluation of pericardial fluid cytology performed to date. MATERIAL AND METHODS Pericardial effusion specimens from 145 patients collected over a 25 [corrected] year period were studied by cytology [corrected]. The minimum pericardial fluid volume used for adequate cytologic diagnosis in these patients was more than 60 mL. RESULTS Cytological diagnosis revealed malignant pericardial exudates in 100% of the studied patients [corrected]. CONCLUSIONS Cytology provides an immediate and accurate means of diagnosis. Immunocytology is very important
in the diagnostic evaluation.
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Dorota K, Dariusz B, Andrzej P, Ewa FM, Patrycja LK, Grzegorz D. Pericardial tamponade as the first manifestation of bronchial adenocarcinoma. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2016. [DOI: 10.1515/cipms-2016-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Case report. A 58-year-old woman was admitted to the Department of Internal Diseases due to resting dyspnoea, tachycardia and malaise. Her chest X-ray revealed inflammatory lesions, and empiric antibiotic therapy was initiated. Chest CT was then performed which showed lung tumours. During hospitalization, the patient suddenly developed cardiogenic shock induced by pericardial tamponade. The fluid from pericardium was subsequently collected. An histopathological examination of the fluid showed the presence of atypical cells. The patient then underwent bronchoscopy, the biopsy material of which revealed bronchial adenocarcinoma.
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Affiliation(s)
- Kuzemko Dorota
- Chair and Department of Internal Diseases Medical University of Lublin Independent Clinical Hospital No. 1 in Lublin, Staszica 16, 20-081 Lublin, Poland
| | - Baranowski Dariusz
- Chair and Department of Internal Diseases Medical University of Lublin Independent Clinical Hospital No. 1 in Lublin, Staszica 16, 20-081 Lublin, Poland
| | - Prystupa Andrzej
- Chair and Department of Internal Diseases Medical University of Lublin Independent Clinical Hospital No. 1 in Lublin, Staszica 16, 20-081 Lublin, Poland
| | | | - Lachowska-Kotowska Patrycja
- Chair and Department of Internal Diseases Medical University of Lublin Independent Clinical Hospital No. 1 in Lublin, Staszica 16, 20-081 Lublin, Poland
| | - Dzida Grzegorz
- Chair and Department of Internal Diseases Medical University of Lublin Independent Clinical Hospital No. 1 in Lublin, Staszica 16, 20-081 Lublin, Poland
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Numico G, Cristofano A, Occelli M, Sicuro M, Mozzicafreddo A, Fea E, Colantonio I, Merlano M, Piovano P, Silvestris N. Prolonged Drainage and Intrapericardial Bleomycin Administration for Cardiac Tamponade Secondary to Cancer-Related Pericardial Effusion. Medicine (Baltimore) 2016; 95:e3273. [PMID: 27082564 PMCID: PMC4839808 DOI: 10.1097/md.0000000000003273] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Malignant pericardial effusion (MPE) is a serious complication of several cancers. The most commonly involved solid tumors are lung and breast cancer. MPE can give rise to the clinical picture of cardiac tamponade, a life threatening condition that needs immediate drainage. While simple pericardiocentesis allows resolution of the symptoms, MPE frequently relapses unless further procedures are performed. Prolonged drainage, talcage with antineoplastic agents, or surgical creation of a pleuro-pericardial window are the most commonly suggested ones. They all result in MPE resolution and high rates of long-term control. Patients suitable for further systemic treatments can have a good prognosis irrespective of the pericardial site of disease. We prospectively enrolled patients with cardiac tamponade treated with prolonged drainage associated with Bleomycin administration. Twenty-two consecutive patients with MPE and associated signs of hemodynamical compromise underwent prolonged drainage and subsequent Bleomycin administration. After injection of 100 mg lidocaine hydrochloride, 10 mg Bleomycin was injected into the pericardial space. The catheter was clumped for 48 h and then reopened. Removal was performed when the drainage volume was <25 mL daily. Twelve patients (54%) achieved complete response and 9 (41%) a partial response. Only 1 (5%) had a treatment failure and underwent a successful surgical procedure. Acute toxicity was of a low degree and occurred in 7 patients (32%). It consisted mainly in thoracic pain and supraventricular arrhythmia. The 1-year pericardial effusion progression-free survival rate was 74.0% (95% confidence interval [CI]: 51.0-97.3). At a median follow-up of 75 months, a pericardial progression was detected in 4 patients (18%). One- and two-year overall survival rates were 33.9% (95% CI: 13.6-54.2) and 14.5% (95% CI: 0.0-29.5), respectively, with lung cancer patients having a shorter survival than breast cancer patients. The worst prognosis, however, was shown in patients not suitable for systemic treatments, irrespective of the site of the primary tumor.Prolonged drainage and intrapericardial Bleomycin is a safe and effective treatment, which should be considered as first choice at least in patients suitable for active systemic treatment.
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Affiliation(s)
- Gianmauro Numico
- From the Medical Oncology, Azienda Ospedaliera SS Antonio e Biagio e C Arrigo, Alessandria (GN, PP); Medical Oncology and Hematology (AC, AM) and Cardiology (MS), Azienda USL della Valle d'Aosta, Aosta; Medical Oncology, Azienda Ospedaliera S. Croce e Carle, Cuneo (MO, EF, IC, MM); and Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", Bari (NS), Italy
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Sánchez-Enrique C, Nuñez-Gil IJ, Viana-Tejedor A, De Agustín A, Vivas D, Palacios-Rubio J, Vilchez JP, Cecconi A, Macaya C, Fernández-Ortiz A. Cause and Long-Term Outcome of Cardiac Tamponade. Am J Cardiol 2016; 117:664-669. [PMID: 26718232 DOI: 10.1016/j.amjcard.2015.11.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/12/2015] [Accepted: 11/12/2015] [Indexed: 11/15/2022]
Abstract
Cardiac tamponade is a life-threatening condition, whose current specific cause and outcome are unknown. Our purpose was to analyze it. We performed a retrospective observational study with prospective follow-up data including 136 consecutive patients admitted with diagnosis of cardiac tamponade, from 2003 to 2013. We thoroughly recorded variables as clinical features, drainage/pericardiocentesis, fluid characteristics, and long-term events (new cardiac tamponade ± death). The median age was 65 ± 17 years (55% men). In the baseline characteristics, 70% were no smokers, 12% were on anticoagulation, and 13 had suffered a previous myocardial infarction. In the preceding month, 15 patients had undergone a cardiac catheterization, 5 cardiac surgery, and 5 pacemaker insertion. Fever was observed in 16% of patients and 21% displayed other inflammatory symptoms. In 81% of patients, pericardiocentesis was needed. The fluid was hemorrhagic or a transudate in the majority, with positive cytology in 15% and bacteria in 3.7%. Main causes were malignancy (32%), infection (24%), idiopathic (16%), iatrogenic (15%), postmyocardial infarction (7%), uremic (4%), and other causes (2%). After a maximum follow-up of 10.4 years, cardiac tamponade recurred in 10% of the cases (62% in the neoplastic group) and the 48% of patients died (89% in the neoplastic cohort). In conclusion, most cardiac tamponades are due to malignancy, having this specific cause a poorer outcome, probably as a manifestation of an advanced disease. The rest of causes, after an aggressive intensive management, have a good prognosis, especially the iatrogenic.
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Affiliation(s)
| | - Iván J Nuñez-Gil
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
| | | | | | - David Vivas
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Alberto Cecconi
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Macaya
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
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Malignant Cardiac Tamponade from Non-Small Cell Lung Cancer: Case Series from the Era of Molecular Targeted Therapy. J Clin Med 2014; 4:75-84. [PMID: 26237019 PMCID: PMC4470240 DOI: 10.3390/jcm4010075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/16/2014] [Indexed: 11/27/2022] Open
Abstract
Cardiac tamponade complicating malignant pericardial effusion from non-small cell lung cancer (NSCLC) is generally associated with extremely poor prognosis. With improved systemic chemotherapy and molecular targeted therapy for NSCLC in recent years, the prognosis of such patients and the value of invasive cardiothoracic surgery in this setting have not been adequately examined. We report outcomes from a contemporary case series of eight patients who presented with malignant cardiac tamponade due to NSCLC to an Australian academic medical institution over an 18 months period. Two cases of cardiac tamponade were de novo presentations of NSCLC and six cases were presentations following previous therapy for NSCLC. The median survival was 4.5 months with a range between 9 days to alive beyond 17 months. The two longest survivors are still receiving active therapy at 17 and 15 months after invasive surgical pericardial window respectively. One survivor had a histological subtype of large cell neuroendocrine carcinoma and the other received targeted therapy for epidermal growth factor receptor mutation. These results support the consideration of active surgical palliation to treating this oncological emergency complicating NSCLC, including the use of urgent drainage, surgical creation of pericardial window followed by appropriate systemic therapy in suitably fit patients.
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17
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Jeon HW, Cho DG, Park JK, Hyun KY, Choi SY, Suh JH, Kim YD. Prognostic factors affecting survival of patients with cancer-related pericardial effusion managed by surgery. World J Surg Oncol 2014; 12:249. [PMID: 25091001 PMCID: PMC4237959 DOI: 10.1186/1477-7819-12-249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 07/20/2014] [Indexed: 11/20/2022] Open
Abstract
Background Although pericardial effusion (PE) is not uncommon in patients with cancer, it may lead to cardiac tamponade, a life-threatening condition. Prompt life-saving treatment is essential, and also allows the continuation of the cancer treatment. The aim of this study was to determine the prognostic factors for survival in patients with cancer who were treated surgically for PE. Methods We retrospectively reviewed the medical records of 55 patients with cancer with PE between January 2003 and October 2012, who were treated with a pericardial window operation. Overall survival (OS) was estimated from the date of surgery, and patients were followed until the time of the final visit or time of death. Clinical outcomes and candidate prognostic factors were analyzed. Results The median age of patients was 57 years (range 29 to 82 years), and 31 patients (56.4%) were male. The most common primary malignancy was lung cancer (65.5%), followed by breast cancer (10.9%). Fifteen patients (27.3%) developed recurrence of PE after surgery. The median OS duration was 4 months (range 0 to 39 months). Multivariate analysis found that evidence of pericardial metastasis on preoperative imaging (P = 0.029) and confirmation of malignant cells in the PE and/or pericardial tissue (P = 0.034) were associated with reduced OS. Conclusion Evidence of pericardial metastasis on preoperative imaging and cytopathologic confirmation that the PE and/or pericardial tissue are positive for malignant cells can be used to predict poor clinical outcomes in patients with cancer-related PE.
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Affiliation(s)
| | | | | | | | | | | | - Young-Du Kim
- Department of Thoracic and Cardiovascular Surgery, Bucheon St, Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul 137-701, Seocho-gu, Republic of Korea.
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Kumar A, Puttanna A. Recurrent cardiac tamponade: an initial presentation of lung adenocarcinoma. BMJ Case Rep 2014; 2014:bcr-2013-202553. [PMID: 24850550 DOI: 10.1136/bcr-2013-202553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 63-year-old hypertensive woman presented initially to the surgical team with right upper quadrant pain, the patient was otherwise asymptomatic and clinically well. An abdominal CT scan excluded any surgical diagnoses but rather showed a pericardial effusion. When the cardiology team urgently reviewed her, they found her to be hypotensive and tachycardic with a raised jugular venous pressure. A diagnosis of cardiac tamponade was made and was transferred to the coronary care unit for an emergency pericardiocentesis. She developed tamponade on further occasions requiring pericardiocentesis. The underlying cause was investigated and following pericardial fluid analysis and subsequent imaging, metastatic lung adenocarcinoma was diagnosed.
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Rousseau-Bussac G, Crequit P, Alifano M, Chouaid C. [Management of malignant pericardial effusion in lung cancer]. Rev Mal Respir 2014; 31:746-53. [PMID: 25391509 DOI: 10.1016/j.rmr.2014.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 02/06/2014] [Indexed: 01/19/2023]
Abstract
Acute pericarditis associated with lung cancer is a relatively frequent complication but is usually not symptomatic unless it causes tamponade. The clinical presentation is classically with dyspnea, thoracic pain, signs of right cardiac failure then left cardiac failure and syncope but it is often a difficult diagnosis in a patient with multi-symptomatic disease. The diagnosis is based on cardiac echography. Toxicity due to radiotherapy or more rarely an infectious etiology must be considered. Clinically significant effusions must be drained because of the high rate of recurrence after a simple aspiration. Drainage is formally indicated when, at echocardiography, the effusion exceeds 20mm in diastole, in cases of tamponade or in cases of compromised hemodynamic status. The formation of a pericardial window at thoracotomy prevents recurrences. Based on old, retrospective, very heterogeneous case series the prognosis, is generally considered to be poor with a median survival which does not exceed 100 days and a one year survival generally lower than 10%. Prognosis is better where diagnosis occurs at an earlier stage allowing regular follow-up and surgical intervention in a non-emergency setting.
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Affiliation(s)
| | - P Crequit
- Service de pneumologie, hôpital Saint-Antoine, Paris, France
| | - M Alifano
- Service de chirurgie thoracique, hôpital Cochin, Paris, France
| | - C Chouaid
- Service de pneumologie, hôpital Saint-Antoine, Paris, France; Service de pneumologie et de pathologie professionnelle, CHI de Créteil, 40, avenue de Verdun, 94010 Créteil, France.
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Celik S, Celik M, Aydemir B, Tanrıkulu H, Okay T, Tanrikulu N. Surgical properties and survival of a pericardial window via left minithoracotomy for benign and malignant pericardial tamponade in cancer patients. World J Surg Oncol 2012; 10:123. [PMID: 22742716 PMCID: PMC3499191 DOI: 10.1186/1477-7819-10-123] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 06/02/2012] [Indexed: 01/31/2023] Open
Abstract
Background Surgical drainage is a rapid and effective treatment for pericardial tamponade in cancer patients. We aimed to investigate the effectiveness of pericardial window formation via mini-thoracotomy for treating pericardial tamponade in cancer patients, and to evaluate clinical factors affecting long-term survival. Methods Records of 53 cancer patients with pericardial tamponade treated by pericardial window formation between 2002 and 2008 were examined. Five patients were excluded due to insufficient data. Kaplan-Meier and Cox regression analysis were used for analysis. Results Forty-eight patients (64.7% male), with a mean age of 55.20 ± 12.97 years were included. Patients were followed up until the last control visit or death. There was no surgery-related mortality and the 30-day mortality rate was 8.33%; all died during postoperative hospitalization. Morbidity rate was 18.75%. Symptomatic recurrence rate was 2.08%. Cancer type and nature of the pericardial effusion were the major factors determining long-term survival (P <0.001 and P <0.004, respectively). Overall median survival was 10.41 ± 1.79 months. One- and 2-year survival rates were 45 ± 7% and 18 ± 5%, respectively. Conclusion Pericardial window creation via minithoracotomy was proven to be a safe and effective approach in surgical treatment of pericardial tamponade in cancer patients. Cancer type and nature of pericardial effusion were the main factors affecting long-term survival.
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Affiliation(s)
- Sezai Celik
- Department of Thoracic Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
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Rovere RK, De Araujo DB, Ribeiro DRP, Marques RT. Pericardial Breast Cancer Metastasis 25 Years after Mastectomy. TUMORI JOURNAL 2012; 98:e7-9. [DOI: 10.1177/030089161209800128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pericardial effusion in a patient with a history of cancer should always prompt a hypothesis of malignant involvement. We report the case of a 66-year-old white woman presenting with pericardial effusion 25 years after a mastectomy for ductal breast carcinoma. This is one of the cases with the latest recurrence ever reported.
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Affiliation(s)
| | - Daniel Brito De Araujo
- Department of Rheumatology, Hospital do Servidor Público Estadual de São Paulo, São Paulo (SP)
| | - Daniel Rios Pinto Ribeiro
- Department of Internal Medicine, Hospital Escola, Universidade Federal de Pelotas, Pelotas (RS), Brazil
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Lestuzzi C, Bearz A, Lafaras C, Gralec R, Cervesato E, Tomkowski W, DeBiasio M, Viel E, Bishiniotis T, Platogiannis DN, Buonadonna A, Tartuferi L, Piazza R, Tumolo S, Berretta M, Santini F, Imazio M. Neoplastic pericardial disease in lung cancer: impact on outcomes of different treatment strategies. A multicenter study. Lung Cancer 2010; 72:340-7. [PMID: 21122938 DOI: 10.1016/j.lungcan.2010.10.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 10/23/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND Local (intrapericardial) chemotherapy has been reported to be useful for the treatment of neoplastic pericardial disease, but it has never been compared to systemic chemotherapy, a combination of the two and simple pericardial drainage or sclerosis. METHODS We analyzed the clinical and echocardiographic data of 119 patients, suffering of neoplastic pericarditis due to lung cancer (97 with non-small-cell), comparing the outcomes of four different treatment strategies (extended catheter drainage/sclerosis, systemic chemotherapy, local chemotherapy, and combined - local plus systemic - chemotherapy) at the last available follow-up or at the change of therapy after a treatment failure. The outcomes (based on semiquantitative evaluation of pericardial disease) were classified as complete, partial, no response and progressing disease. RESULTS A complete response was achieved in 37/53 of patients with combined, in 12/22 with local, in 5/27 with systemic chemotherapy, respectively, and in 4/17 after drainage/sclerosis (p<0.001). Overall response was achieved in 51/53 with combined, 18/22 and 16/27 with local or systemic chemotherapy, respectively, and in 5/17 with drainage/sclerosis only (p<0.001). Survival was significantly better after combined chemotherapy (p<0.001) and 12/53 patients (23%) in this subgroup survived more than 1 year. The overall response rate was higher with intrapericardial cisplatinum than with other agents (98% vs 80%, χ(2)=7.69, p<0.01). CONCLUSIONS Local chemotherapy, alone or with systemic chemotherapy, is effective in treating pericardial metastases from lung carcinoma, leading to a good control of pericardial effusion in 92% of cases, and to complete disappearance of effusion and masses in 65%. Combined therapy is significantly better than any other treatment. Pericardiocentesis and intrapericardial chemotherapy should be used whenever possible in lung cancer neoplastic pericardial disease, not only in case of tamponade.
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Affiliation(s)
- Chiara Lestuzzi
- Division of Cardiology, CRO, Centro di Riferimento Oncologico (National Cancer Institute), Aviano, Pordenone, Italy.
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Bois JP, Valles AG, Sinak LJ. 78-year-old man with metastatic squamous cell carcinoma, dyspnea, and hypotension. Mayo Clin Proc 2010; 85:e78-81. [PMID: 21037039 PMCID: PMC2966371 DOI: 10.4065/mcp.2010.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- John P. Bois
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Alfred G. Valles
- Resident in Cardiovascular Diseases, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Lawrence J. Sinak
- Adviser to residents and Consultant in Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
- Individual reprints of this article are not available. Address correspondence to Lawrence J. Sinak, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ()
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Apodaca-Cruz Á, Villarreal-Garza C, Torres-Ávila B, Torres J, Meneses A, Flores-Estrada D, Lara-Medina F, Arrieta Ó. Effectiveness and prognosis of initial pericardiocentesis in the primary management of malignant pericardial effusion. Interact Cardiovasc Thorac Surg 2010; 11:154-61. [DOI: 10.1510/icvts.2010.232546] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Tsai YT, Kuo SW, Hao SP. Cardiac tamponade: a rare presentation from a rare metastatic site in oral squamous cell carcinoma. Eur Arch Otorhinolaryngol 2010; 267:1483-5. [PMID: 20563591 DOI: 10.1007/s00405-010-1304-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 06/02/2010] [Indexed: 11/26/2022]
Abstract
Metastatic head and neck squamous cell carcinoma (HNSCC) is a rare cause of cardiac tamponade. We report on a 62-year-old male who presented with metastatic squamous cell carcinoma (SCC) that caused cardiac tamponade secondary to a primary SCC originating from the retromolar trigone of the oral cavity. The clinical diagnosis was confirmed by physical examination, echocardiography and complete resolution of symptoms after pericardial fluid drainage. Cytologic examination of the pericardial fluid was the only investigational tool able to render a definitive evidence of malignant pericardial effusion. However, evidence of a hemorrhagic pericardial effusion must raise the suspicion of a malignant etiology regardless of the result of the cytologic examination. Metastatic HNSCC may involve multiple organ systems including the heart. We report this rare clinical presentation of cardiac tamponade as the initial location of distant metastasis. Otolaryngologists should keep a high index of suspicion and pay special attention to the symptoms arising on the non-head and neck sites to establish an early diagnosis and prompt management of the disease process.
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Affiliation(s)
- Yao-Te Tsai
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, No. 5, Fu Shin Street, Kweishan, Taoyuan, Taiwan, R. O. C.
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Malignant pericardial effusion: sclerotherapy or local chemotherapy? Br J Cancer 2009; 101:734-5; author reply 736-7. [PMID: 19513065 PMCID: PMC2736808 DOI: 10.1038/sj.bjc.6605108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Dequanter D, Lothaire P, Berghmans T, Sculier JP. Severe Pericardial Effusion in Patients with Concurrent Malignancy: A Retrospective Analysis of Prognostic Factors Influencing Survival. Ann Surg Oncol 2008; 15:3268-71. [DOI: 10.1245/s10434-008-0059-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 05/30/2008] [Accepted: 05/30/2008] [Indexed: 01/09/2023]
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Yonemori K, Kunitoh H, Tsuta K, Tamura T, Arai Y, Shimada Y, Fujiwara Y, Sasajima Y, Asamura H, Tamura T. Prognostic factors for malignant pericardial effusion treated by pericardial drainage in solid-malignancy patients. Med Oncol 2008; 24:425-30. [PMID: 17917093 DOI: 10.1007/s12032-007-0033-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 11/30/1999] [Accepted: 05/01/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE Malignant pericardial effusion is a frequent complication of advanced incurable malignancies and requires treatment. The purpose of this study was to identify prognostic factors for cytology-positive malignant pericardial effusion in patients treated by pericardial drainage. METHODS We retrospectively analyzed a series of consecutive patients diagnosed with cytologically positive malignant pericardial effusion who were treated by pericardial drainage at the National Cancer Center Hospital, Tokyo. RESULTS A total of 88 patients with pericardial effusion were treated by pericardial drainage, 60 patients were diagnosed with cytological positive malignant pericardial effusion including 32 with non-small cell lung cancer, 13 with breast cancer, 8 with gastrointestinal cancer, and 7 with miscellaneous cancers. Subxiphoid pericardiostomy was performed in 50 of the patients and percutaneous tube pericardiostomy in the other 10 patients. Malignant pericardial effusion recurred in 14 patients, and pericardial drainage was performed again in 9 of them. The median overall survival time was 6.1 months, and the 1-year survival rate was 28%. A multivariate analysis revealed the following significant negative prognostic factors: performance status, development of malignant pericardial effusion during chemotherapy, mediastinal lymph node enlargement, and cytologic type. (P = 0.03, 0.02, 0.01, 0.001, respectively). CONCLUSION Patients with poor prognostic factors may be better to consider as indication of palliative therapy, even if oncologic emergency had been resolved rapidly by drainage.
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Affiliation(s)
- Kan Yonemori
- Division of Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan.
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Fernández-Ruiz M, Aranda-Arcas JL, Alonso-Navas F, Guerra-Vales JM. [Cardiac tamponade as initial clinical manifestation of a non-small cell lung cancer]. Rev Clin Esp 2007; 207:587-9. [PMID: 18021655 DOI: 10.1157/13111586] [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: 11/21/2022]
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Gross JL, Younes RN, Deheinzelin D, Diniz AL, Silva RAD, Haddad FJ. Surgical Management of Symptomatic Pericardial Effusion in Patients with Solid Malignancies. Ann Surg Oncol 2006; 13:1732-8. [PMID: 17028771 DOI: 10.1245/s10434-006-9073-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 02/08/2006] [Accepted: 05/19/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Symptomatic pericardial effusion in patients with cancer may lead to a life-threatening event that requires diligent treatment, but the best surgical treatment is still controversial. The purpose of this study was to identify predictors of survival for patients with solid malignancies and symptomatic pericardial effusion, which might help to select the best surgical treatment for each patient. METHODS We retrospectively analyzed 47 patients with solid malignancies concomitant with symptomatic pericardial effusion who underwent surgery between 1994 and 2004. Overall survival was calculated from date of surgery, and prognostic importance of clinical and pathological variables was assessed. RESULTS The most common primary sites of disease were breast (46.8%) and lung (25.6%). Initial pericardiocentesis were performed in 29 patients; median volume of fluid drained was 480 mL. Median interval from the diagnosis of primary cancer to the development of pericardial effusion (pericardial effusion-free interval) was 34.8 months. Definitive surgical treatment was performed in 43 patients, as follows: subxiphoid pericardial window (n = 21); thoracotomy and pleuropericardial window (n = 10); pericardiodesis (n = 8); and videothoracoscopic pleuropericardial window (n = 4). Pericardiocentesis was the only procedure in four patients. Median follow-up was 2.9 months. Median overall survival was 3.7 months. Pericardial effusion-free interval longer than 35 months and more than 480 mL of fluid drained at initial pericardiocentesis were determinants of better survival. CONCLUSIONS Pericardial window and pericardiodesis seem to be safe and efficacious in treating effusion of the pericardium. Pericardial effusion-free interval and volume drained at initial pericardiocentesis are determinants of outcome.
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Affiliation(s)
- Jefferson Luiz Gross
- Department of Thoracic Surgery, Hospital do Cancer A. C. Camargo, Rua Professor Antonio Prudente, 211 Liberdade, São Paulo, SP, 01509-010, Brazil.
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Gornik HL, Gerhard-Herman M, Beckman JA. Abnormal cytology predicts poor prognosis in cancer patients with pericardial effusion. J Clin Oncol 2005; 23:5211-6. [PMID: 16051963 DOI: 10.1200/jco.2005.00.745] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Pericardial tamponade is a life-threatening disorder caused by varying medical conditions. Malignancy and complications of its treatment are a common cause of pericardial effusion. The natural history of pericardial effusion remains largely unknown. We investigated the association of malignancy with adverse outcomes after pericardiocentesis. PATIENTS AND METHODS Consecutive patients undergoing pericardiocentesis at a single institution between January 1, 1999, and January 31, 2003, were included. Death was confirmed with the Social Security Death Index. Survival estimates were obtained by the Kaplan-Meier method. Cox regression was performed to determine the clinical characteristics associated with death. RESULTS Two hundred nineteen patients underwent pericardiocentesis during the study period. The effusion was cancer-related in 43.8% of cases. Median survival was 59.6 weeks (95% CI, 24.3 to 94.8 weeks). During the follow-up period, 47.9% of patients died. Cancer-related pericardial effusion was associated with decreased survival (median, 15.1 weeks). Abnormal fluid cytology was further associated with poor prognosis among patients with malignancy (median survival, 7.3 v 29.7 weeks; P = .022). Patients with cancer-related pericardial effusion were more likely to require repeat pericardiocentesis (OR = 6.0; P = .001) and pericardial surgery (odds ratio [OR] OR = 5.7; P < .001). Cancer-related effusion and abnormal cytology were independent predictors of death in a multivariate model. CONCLUSION Malignancy is the most common cause of pericardial effusion in a tertiary care center. Cancer-related pericardial effusion is associated with adverse outcomes, and abnormal cytology further worsens prognosis. The poor survival among cancer patients with pericardial effusion and abnormal fluid cytology may have important implications for management.
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Affiliation(s)
- Heather L Gornik
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
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van Walraven C, Davis D, Forster AJ, Wells GA. Time-dependent bias was common in survival analyses published in leading clinical journals. J Clin Epidemiol 2004; 57:672-82. [PMID: 15358395 DOI: 10.1016/j.jclinepi.2003.12.008] [Citation(s) in RCA: 242] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2003] [Indexed: 10/25/2022]
Abstract
OBJECTIVE In survival analysis, "baseline immeasurable" time-dependent factors cannot be recorded at baseline, and change value after patient observation starts. Time-dependent bias can occur if such variables are not analyzed appropriately. This study sought to determine the prevalence of such time-dependent bias in highly-cited medical journals. STUDY DESIGN AND SETTING We searched Medline databases to identify all observational studies that used a survival analysis in American Journal of Medicine, Annals of Internal Medicine, Archives of Internal Medicine, British Medical Journal, Chest, Circulation, Journal of the American Medical Association, Lancet, and New England Journal of Medicine between 1998 and 2002. Studies with "baseline immeasurable" time-dependent factors were susceptible to time-dependent bias if a time-dependent covariate analysis was not used. RESULTS Of 682 eligible studies, 127 (18.6%, 95% CI 15.8-21.8%) contained a "baseline immeasurable" time-dependent factor and 52 (7.6% [5.8-9.9%] of all survival analyses/40.9% [32.3-50.0%] of studies with a time-dependent factor) were susceptible to time-dependent bias. In 35 studies (5.1% [3.7-7.1%]/27.6% [20.5-35.9%]), the bias affected a variable highlighted in the study abstract and correction of the bias could have qualitatively changed the study's conclusion in over half of studies. CONCLUSION In medical journals, time-dependent bias is concerningly common and frequently affects key factors and the study's conclusion.
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Affiliation(s)
- Carl van Walraven
- Department of Medicine, University of Ottawa, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, F-660, Ottawa, ON K1Y 4E9, Canada.
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Cullinane CA, Paz IB, Smith D, Carter N, Grannis FW. Prognostic factors in the surgical management of pericardial effusion in the patient with concurrent malignancy. Chest 2004; 125:1328-34. [PMID: 15078742 DOI: 10.1378/chest.125.4.1328] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Pericardial effusion in the patient with cancer presents a unique management problem. Although multiple methods of operative and nonoperative drainage of pericardial effusions have been described, surgical pericardial window remains the standard approach to long-term drainage. Selecting the patient who may benefit from an operative approach presents a difficult challenge. In the present study, we retrospectively analyzed the clinical outcome of 63 consecutive patients with malignancy who underwent surgical pericardial window for symptomatic pericardial effusion between January 1, 1990, and July 1, 2001, at City of Hope National Medical Center in order to try to determine whether the type of cancer, the presence of malignant cells in pericardial fluid, or tissue specimens or the method of surgery influenced the incidence of recurrent pericardial effusion or duration of survival. METHODS The cohort was comprised of 15 patients with non-small cell lung cancer (NSCLC), 22 patients with breast cancer, 17 patients with hematologic malignancy, and 9 patients with other solid tumors. Pertinent clinical, laboratory, hospital stay, and outcome data including long-term follow-up were recorded. Patients were followed up until the time of last clinical follow-up or death. Univariate survival analyses were performed to determine significant clinical factors contributing to outcome. RESULTS Median follow-up was 6.6 months for the group and 8.3 months for those alive at last follow-up. Median survival rates for patients with lung, breast, hematologic, and other solid-tumor malignancies were 3.2 months, 8.8 months, 17 months, and 16.4 months, respectively. Preoperative factors that negatively correlated with survival included a diagnosis of NSCLC (p = 0.0014), the presence of a pleural effusion (p = 0.003), or positive pathologic (p = 0.02) or cytologic findings (p = 0.02). CONCLUSIONS A surgical approach to pericardial drainage is effective (< 5% failure rate) and provides an opportunity for continued therapy with the potential for relief of dyspnea and improvement in quality of life and survival in selected patients.
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Affiliation(s)
- Carey A Cullinane
- Division of General Oncologic Surgery, City of Hope National Medical Center, Los Angeles, CA, USA
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Derrames pericárdicos significativos asociados a tumores: análisis de 18 casos. Rev Clin Esp 2004. [DOI: 10.1016/s0014-2565(04)71452-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nguyen Ba V, Debien B, Villevieille T, Quiniou G, Pollet L, Lenoir B, Pats B. L’embolie pulmonaire au secours de la tamponnade cardiaque. ACTA ACUST UNITED AC 2003; 22:896-9. [PMID: 14644373 DOI: 10.1016/j.annfar.2003.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The association of cardiac tamponade and pulmonary embolism has not previously been described. We report the case of a patient, who presented with such an association, due to an underlying pulmonary carcinoma. When a major pericardial effusion is associated with pulmonary hypertension, some echocardiographic signs of tamponade may appear, such as a moderate right ventricular collapse, or the absence of a paradoxical septum. The presence of pulmonary hypertension in this context of tamponade may have paradoxically saved the life of this patient.
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Affiliation(s)
- V Nguyen Ba
- Département d'anesthésie-réanimation, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92141 Clamart, France
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Lindenberger M, Kjellberg M, Karlsson E, Wranne B. Pericardiocentesis guided by 2-D echocardiography: the method of choice for treatment of pericardial effusion. J Intern Med 2003; 253:411-7. [PMID: 12653869 DOI: 10.1046/j.1365-2796.2003.01103.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Percutaneous pericardiocentesis guided by 2-D echocardiography has been used at Linköping Heart Centre since 1983. AIM To evaluate our experience of this method including a follow-up and also to determine the aetiology of pericardial effusion. METHODS A retrospective study including 120 of 252 consecutive patients punctured. RESULTS The two most common aetiologies were cardiac surgery (77% valve surgery), followed by malignant disease. The postsurgical effusions became clinically important a median of 12 days after surgery (range 0-56 days). The median survival in the group with malignant disease was 89 days (30-day survival 87%, 1-year survival 10%). Indwelling catheter was used in 93% of the patients. There was no mortality but one patient needed a second pericardiocentesis after an accidental puncture of the right ventricle. Nine patients had rhythm aberrations. Recurring effusion that needed puncture was seen in 8%. CONCLUSION Pericardiocentesis guided by 2-D echocardiography is a safe and efficient method to treat pericardial effusion and also valuable as palliative treatment for patients with malignant aetiology of the effusion.
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Affiliation(s)
- M Lindenberger
- Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Sweden
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Abstract
The perioperative care of patients with cancer can be an exciting challenge. The physician must consider many factors, including the cancer diagnosis, the extent of disease, treatment received, the presence of comorbid conditions, and the patient's prognosis and must understand the impact of these factors on the planned surgical procedure. In this setting, the physician has the opportunity to perform an essential role in the perioperative management of patients with cancer.
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Affiliation(s)
- Ellen F Manzullo
- Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 437, Houston, TX 77030, USA.
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