Intrapericardial cisplatin administration after pericardiocentesis in patients with lung adenocarcinoma and malignant cardiac tamponade.

INTRODUCTION: Patients with lung adenocarcinoma often suffer from metastatic pericardial effusion that may eventually cause cardiac tamponade. Recurrence of pericardial effusion is frequent after pericardial drainage and therapy for the prevention of fluid reaccumulation is still controversial. We evaluated the safety and effectiveness of the intrapericardial infusion of cisplatin, a substance with antineoplastic and sclerosing properties, after pericardiocentesis in patients with lung adenocarcinoma and malignant cardiac tamponade.

METHODS: Twenty-five patients (19 males and 6 females, median age 55 years) with lung adenocarcinoma confirmed by cytological examination and cardiac tamponade were studied. All patients underwent subxiphoid pericardiocentesis through catheter insertion, under electrocardiographic, echocardiographic and haemodynamic guidance. After the malignant aetiology of the pericardial effusion had been confirmed by cytological examination, cisplatin was instilled (10 mg in 20 ml normal saline) into the pericardial cavity during three consecutive days. Clinical and echocardiographic evaluation was performed every month thereafter.

RESULTS: Pericardial fluid of 350-1700 ml was removed (median 750 ml) and was haemorrhagic in 80% of the cases. Paroxysmal atrial fibrillation was detected in three patients (12%) and non-sustained ventricular tachycardia in two (8%). None of the patients had hypotension or retrosternal pain. One patient suffered from significant pericardial effusion reaccumulation (4%). Laboratory findings were not influenced by systemic drug absorption in any patient. Transthoracic echocardiographic study revealed pericardial thickening without physiology of constriction in 4 patients (16%). After pericardiocentesis, the mean survival period overall was 4.5 months (range 3-92 weeks), and mortality was attributed to widespread disease (respiratory failure).

CONCLUSIONS: Intrapericardial administration of cisplatin is safe and effective in preventing the reaccumulation of malignant pericardial effusion in the majority of patients with lung adenocarcinoma.