Neoplastic pericardial disease in lung cancer: impact on outcomes of different treatment strategies. A multicenter study.

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.

• Authors: Chiara Lestuzzi, Alessandra Bearz, Christos Lafaras, Renata Gralec, Eugenio Cervesato, Witold Tomkowski, Marzia DeBiasio, Elda Viel, Theodoros Bishiniotis, Dimitrios N Platogiannis, Angela Buonadonna, Lucia Tartuferi, Rita Piazza, Salvatore Tumolo, Massimiliano Berretta, Francesco Santini, Massimo Imazio
• Journal: Lung cancer (Amsterdam, Netherlands) (Lung Cancer) Vol. 72 Issue 3 Pg. 340-7 (Jun 2011) ISSN: 1872-8332 [Electronic] Ireland
• PMID: 21122938 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Non-Small-Cell Lung (diagnosis, physiopathology, secondary, therapy)
• Catheterization
• Combined Modality Therapy
• Disease Progression
• Echocardiography
• Female
• Follow-Up Studies
• Heart Neoplasms (diagnosis, physiopathology, secondary, therapy)
• Humans
• Lung Neoplasms (diagnosis, pathology, physiopathology, therapy)
• Male
• Middle Aged
• Pericardial Effusion
• Pericarditis
• Treatment Outcome