Intrapericardial Instillation of Mitoxantrone in Palliative Therapy of Malignant Pericardial Effusion

Musch, E.; Gremmler, B.; Nitsch, Jürgen R.; Rieger, Johannes; Malek, Mouhamad; Chrissafidou, Angeliki

doi:10.1159/000069833

Cited by 14 publications

(8 citation statements)

References 19 publications

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“…Of the underlying primary tumours, 36.5% are lung cancer [12]. The pericardial tumour spread causes typically malignant pericardial effusion (MPE).…”

Section: Pericardial Effusionmentioning

confidence: 99%

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Advanced Malignant Lung Disease: What the Specialist Can Offer

Gompelmann

Eberhardt

Herth³

2011

Respiration

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Lung cancer is not only the most commonly diagnosed cancer worldwide, but it is still the leading cause for cancer-related death. The 5-year survival for lung cancer in Europe and in the USA is totally 16%. Therefore, a palliative therapy regimen is required to control the disease and reduce symptoms with the objective of enhancing quality of life of lung cancer patients. In addition to chemotherapy that is still one of the most important pillars in the treatment of advanced lung cancer, further interventional strategies can be offered to improve a patient’s quality of life. A locoregional tumour progression is frequently associated with malignant pleural effusion or pericardial effusion, central airway obstruction, tracheo-oesophageal fistula, severe haemoptysis or superior vena cava (SVC) syndrome threatening life and necessitating urgent palliation. Recurrent pleural effusion causing dyspnoea can be managed by pleurodesis, serial thoracocentesis or insertion of an indwelling catheter. Symptomatic malignant pericardial effusion often requires an urgent pericardiocentesis. Furthermore, surgical procedures, instillation of sclerosing agents or local chemotherapy should be considered in refractory pericardial effusion. The therapy regimen of central airway stenosis includes mechanical and thermic endoscopic procedures providing rapid relief of symptoms. To prevent recurrence of airway obstruction, the insertion of a stent or palliative brachytherapy provide re-establishment of the patency of obstructed airways. Haemoptysis can be managed by bronchoscopic interventions as well as by arterial embolization or palliative thoracic radiotherapy. The therapy of SVC syndrome is dependent of histology. In small-cell lung cancer, chemotherapy is recommended. In non-small-cell lung cancer, stent insertion and/or radiotherapy are the therapeutic pillars.

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“…Of the underlying primary tumours, 36.5% are lung cancer [12]. The pericardial tumour spread causes typically malignant pericardial effusion (MPE).…”

Section: Pericardial Effusionmentioning

confidence: 99%

“…Carboplatin [22], cisplatin [23] or mitoxantrone [12] for example can be used for intrapericardial instillation to achieve control of refractory pericardial effusion.…”

Section: Pericardial Effusionmentioning

confidence: 99%

Advanced Malignant Lung Disease: What the Specialist Can Offer

Gompelmann

Eberhardt

Herth³

2011

Respiration

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“…nitrogen mustard, mitomycin C, mitoxantrone, 5-fluorouracil, but only case reports or small series have been published, making it impossible to judge the response rates [57,[115][116][117] . Musch et al [118] in 2003, reported 12 complete remissions and 3 partial remissions (small pericardial effusion) among 16 patients (8 bronchial, 7 breast, 1 stomach carcinoma) treated with 10-20 mg of mitoxantrone left in the pericardium for 24 h; the follow-up lasted 28-730 d (mean 6 mo). In a multicenter series of various tumors, the mean effusion-free period of the patients treated with local chemotherapy (various agents) was 372 d (median 223 d); at 1, 2, 6 and 12 mo, 58%, 52%, 33% and 16%, respectively, were completely effusion-free.…”

Section: Local Chemotherapymentioning

confidence: 99%

Neoplastic pericardial disease: Old and current strategies for diagnosis and management

Lestuzzi¹

2010

WJC

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The prevalence of neoplastic pericardial diseases has changed over time and varies according to diagnostic methods. The diagnostic factor is usually the detection of neoplastic cells within the pericardial fluid or in specimens of pericardium, but the diagnosis may be difficult. Accurate sampling and cytopreparatory techniques, together with ancillary studies, including immunohistochemical tests and neoplastic marker dosage, are essential to obtain a reliable diagnosis. The goals of treatment may be simply to relieve symptoms (cardiac tamponade or dyspnea), to prevent recurrent effusion for a long-term symptomatic benefit, or to treat the local neoplastic disease with the aim of prolonging survival. Immediate relief of symptoms may be obtained with percutaneous drainage or with a surgical approach. For long term prevention of recurrences, various approaches have been proposed: extended drainage, pericardial window (surgical or percutaneous balloon pericardiostomy), sclerosing local therapy, local and/or systemic chemotherapy or radiation therapy (RT) (external or with intrapericardial radionuclides). The outcomes of various therapeutic approaches vary for different tumor types. Lymphoma and leukemias can be successfully treated with systemic chemotherapy; for solid tumors, percutaneous drainage and the use of systemic and/or local sclerosing and antineoplastic therapy seems to offer the best chance of success. The use of "pure" sclerosing agents has been replaced by agents with both sclerosing and antineoplastic activity (bleomycin or thiotepa), which seems to be quite effective in breast cancer, at least when associated with systemic chemotherapy. Local chemotherapy with platinum, mitoxantrone and other agents may lead to good local control of the disease, but the addition of systemic chemotherapy is probably relevant in order to prolong survival. The surgical approach (creation of a pericardial window, even with the mini-invasive method of balloon pericardiostomy) and RT may be useful in recurring effusions or in cases that are refractory to other therapeutic approaches.

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“…Most previous studies involving mitoxantrone have included mixed study populations with a wide array of primary cancers and/or different intracavitary sites (pleural, peritoneal, or pericardial) for pleurodesis (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Only a few, thus far, have focussed specifically on a select group of neoplasms of interest, such as breast cancer (20), ovarian cancer (2), or metastatic sarcoma (21), but not lung cancer.…”

Section: Introductionmentioning

confidence: 99%