INTRACAVITARY CHEMOTHERAPY WITH THIOTEPA IN MALIGNANT PERICARDIAL-EFFUSIONS - AN ACTIVE AND WELL-TOLERATED REGIMEN

Purpose: Malignant pericardial effusion, although highly variable, is an uncommon complication of cancer. It is often associated with sympto ms like dyspnea, chest pain, and cough, which may be severe and disabl ing. We analyzed the results of our current treatment policy to evalua te the effectiveness and tolerance of a new approach for this disorder . Patients and Methods: Patients with malignant pericardial effusions were treated with intracavitary thiotepa (15 mg on days 1, 3, and 5) t hrough an indwelling pericardial cannula after extraction of as much p ericardial fluid as possible on day 0. Responses were assessed by clin ical examination, computed tomographic (CT) scan, and echocardiography before treatment, I month after treatment, and every 2 months thereaf ter. Twenty-three patients with malignant symptomatic pericardial effu sion were treated and all were assessable for effectiveness and tolera nce of the procedure. Results: Nine patients with breast cancer, 11 wi th lung cancer, two with on unknown primary tumor, and one with metast atic melanoma were treated. In all but three patients, systemic medica l treatment was started after completion of intracavitary therapy Nine teen patients responded ta treatment (83%; 95% confidence interval, 61 % to 95%) with a rapid improvement of symptoms. The median time to per icardial effusion progression was 8.9 months (range, 1 to 26). No sign ificant side effects were registered, except one patient who had trans ient grade III thrombocytopenia and leukopenia and one patient who had grade I leukopenia. Conclusion: A short course of intracavitary treat ment with thiotepa is highly effective and well tolerated in the treat ment of malignant pericardial effusion. (C) 1998 by American Society o f Clinical Oncology.