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首页> 外文期刊>Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer >Evaluation of intrapericardial cisplatin administration in cases with recurrent malignant pericardial effusion and cardiac tamponade
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Evaluation of intrapericardial cisplatin administration in cases with recurrent malignant pericardial effusion and cardiac tamponade

机译：反复恶性心包积液和心脏压塞患者心包内顺铂的评价

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Goals: To evaluate the effectiveness and side effects of intrapericardial administration of cisplatin in prevention of recurrent malignant pericardial effusion. Patients and methods: Forty-six patients (33 men, 13 women; mean age 55.6±10.5 years) entered this study. The diagnosis of malignancy was based upon histological examination of samples from primary tumor. The majority of patients suffered from a neoplasm localized in the thorax (41 out of 46 patients; 89%). In 35 cases, pericardiocentesis, and in 11 cases, video-assisted thoracoscopic surgery (VATS) of pericardium was performed. Malignant etiology of pericardial fluid was confirmed by cytological examination, histology being obtained by VATS pericardial biopsy or by echocardiography (ECG). If daily drainage of pericardial fluid observed during 5–7 days exceeded 50 ml, cisplatin was instilled according to one of three regimens: (1) 10 mg of cisplatin dissolved in 20 ml of normal saline administered over 5 min during 5 consecutive days directly into the pericardial space (39 patients); (2) 50 mg of cisplatin dissolved in 100 ml of normal saline administered during 30 min (six patients); and (3) 20 mg of cisplatin dissolved in 40 ml of normal saline administered over 10 min during 5 consecutive days (one patient). Treatment was considered as successful when recurrence of symptoms of large pericardial effusion was not observed in ECG and other interventions directed to the pericardium were not required. Efficacy of investigated treatment was assessed also in the group of patients with survival longer than 30 days. Safety of treatment was assessed in the whole group of patients.Results: Because of advanced malignancy eight out of 46 patients (17.4%) survived less than 30 days. Thirty-eight out of 46 cases (82.6%) survived more than 30 days. Positive effect of intrapericardial treatment with cisplatin was achieved in 43 out of 46 patients (93.5%) in the entire investigated group and in 35 out of 38 patients (92%) who survived more than 30 days. In the subgroup of patients with non-small cell lung cancer (NSCLC) and survival longer than 30 days, high efficacy was documented (29 out of 31 cases; 93.5%). Median survival time in the group of 38 patients who survived more than 30 days was 102.5 days. Atrial fibrillation due to cisplatin administration was observed in seven out of 46 patients (15.2%). Sclerosis of the pericardial space without symptoms of constriction occurred in five out of 46 cases (10.9%). Conclusions: Cisplatin administered directly into the pericardial space is a very effective and relatively safe method of treatment of recurrent malignant pericardial effusion, especially in the course of NSCLC.
机译：目的：评价心包内顺铂在预防复发性恶性心包积液中的有效性和副作用。患者和方法：46例患者（男33例，女13例;平均年龄55.6±10.5岁）进入本研究。恶性肿瘤的诊断基于对原发肿瘤样本的组织学检查。大多数患者患有局限于胸部的肿瘤（46名患者中的41名; 89％）。在35例中，进行了心包穿刺术，在11例中，进行了心包电视胸腔镜手术（VATS）。通过细胞学检查确认心包积液的恶性病因，通过VATS心包活检或超声心动图（ECG）获得组织学。如果在5-7天内观察到的心包积液每日排泄量超过50 ml，则根据以下三种方案之一滴注顺铂：（1）在连续5天的5分钟内将10 mg顺铂溶解在20 ml生理盐水中，连续5天直接注入心包间隙（39例）; （2）30分钟内将50 mg顺铂溶解在100 ml生理盐水中（6例患者）; （3）在连续5天的10分钟内，将20 mg顺铂溶于40 ml生理盐水中（一名患者）。当在ECG中未观察到大心包积液症状的复发且不需要针对心包的其他干预措施时，治疗被认为是成功的。存活时间超过30天的患者组也评估了所研究治疗的有效性。结果：由于晚期恶性肿瘤，46名患者中有8名（17.4％）生存时间少于30天。 46例病例中有38例（82.6％）存活超过30天。在整个研究组的46例患者中，有43例（93.5％）接受了顺铂心包内治疗，并在生存期超过30天的38例患者中，有35例（92％）获得了积极的效果。在非小细胞肺癌（NSCLC）且生存期超过30天的患者亚组中，有很高的疗效（31例中有29例，占93.5％）。存活时间超过30天的38例患者的中位生存时间为102.5天。 46例患者中有7例（15.2％）观察到由于顺铂引起的房颤。 46例中有5例发生无收缩症状的心包空间硬化症（10.9％）。结论：顺铂直接进入心包腔是治疗复发性恶性心包积液的一种非常有效且相对安全的方法，尤其是在NSCLC过程中。

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