MALIGNANCY-RELATED PERICARDIAL-EFFUSION - 127 CASES FROM THE ROSWELL-PARK-CANCER-INSTITUTE

Background. Malignancy-related pericardial effusions may represent a t erminal event in patients with therapeutically unresponsive disease. H owever, select patients with malignancies sensitive to available thera pies may achieve significant improvement in palliation and long term s urvival with prompt recognition and appropriate intervention. Methods. From 1968 to 1994, 150 invasive procedures were performed for the tre atment or diagnosis of pericardial effusion in 127 patients with under lying malignancies. These cases were reviewed retrospectively to best identify the clinical features, appropriate diagnostic workup, and opt imal therapy for this complication of malignancy. Results. Dyspnea (81 %) and an abnormal pulsus paradoxus (32%) were the most common symptom s. Echocardiography had a 96% diagnostic accuracy. Cytology and perica rdial biopsy had sensitivities of 90% and 56%, respectively. Fifty-fiv e percent of all effusions were malignant comprising 71% of adenocarci nomas of the lung, breast, esophagus, and unknown primary site. In 57 patients, a malignant effusion could not be determined, and no definit ive etiology could be established for 74% of these effusions. Radiatio n-induced, infectious, and hemorrhagic pericarditis each were identifi ed in fewer than 5% of cases, Conclusions. Subxyphoid pericardiotomy p roved to be a safe and effective intervention that successfully reliev ed pericardial effusions in 99% of cases with recurrence and reoperati on rates of 9% and 7%, respectively. Survival most closely was related to the extent of disease and its inherent chemo-/radiosensitivity, wi th 72% of the patients who survived longer than 1 year having breast c ancer, leukemia, or lymphoma.