INTRAPERICARDIAL APPLICATION OF MITOXANTRONE FOR TREATMENT OF MALIGNANT PERICARDIAL-EFFUSION

Background: Pericardial and myocardial metastases were found in autops y in up to 21% of patients dying of cancer. Clinically significant per icardial effusions occur much less commonly but they require early rec ognition and treatment because cardiac tamponade is potentially fatal. There have been no randomised trials comparing different treatment mo dalities. Material and Methods: From December 1991 until September 199 3 6 patients with malignant pericardial effusion were treated by intra pericardial application of mitoxantrone. Three of these patients had n on-small-cell lung cancer (NSCLC), in 1 case the patient presented wit h pericardial effusion as the first manifestation of malignancy. The o ther patients had high-grade lymphoma (1 patient) and breast cancer (2 patients), respectively. The patients' age ranged from 21 to 60 years . Results: The first draining of pericardial effusion produced an aver age of 1,010 mi of haemorrhagic fluid. In all patients recurrent peric ardial effusion was significantly less but had to be drained for anoth er 2 or 3 times. One or 2 times 10-20 mg of mitoxantrone were applied. No side effects due to the local instillation of mitoxantrone were ob served. Nineteen months after treatment the patient with high-grade ly mphoma shows no signs of pericardial effusion and is still in a partia l remission. Five patients died of progressive disease on follow-up af ter 1, 2, 3 and 14 months and no signs of fluid reaccumuluation were d etected. On autopsy 1 patient (NSCLC) showed pericardial metastases bu t no effusion. Conclusions: The intrapericardial application of mitoxa ntrone seams to be a feasible and effective method to control pericard ial effusion in different malignancies.