Subxiphoid partial pericardiectomy with or without sclerosant instillation in the treatment of symptomatic pericardial effusions in patients with malignancy

Article Abstract:

Patients with metastatic cancer are frequently found at autopsy to have metastatic cancer cells in the heart and the tough pericardium that covers the heart. In the majority of cases, these cells are not present in sufficient numbers to cause symptoms. In some cases, the cancer stimulated the development of pericardial effusions, fluids that collect in the space between the pericardium and the heart. These fluids can impede the beating of the heart, a condition called tamponade, and result in difficulty breathing as well as increased blood pressure in the vena cava returning blood to the heart. The authors review 22 cases in which patients developed symptomatic pericardial effusions as a result of malignancies. The malignant pericardial effusions resulted from breast cancer in 11 patients, from lung cancer in seven patients, and from skin cancer and lymphoma in the remaining patients. In all 22 cases, the pericardial fluid was withdrawn to relieve the tamponade; this procedure was followed by the excision of a 'window' in the pericardium to prevent the reaccumulation of malignant effusions. The pericardium segment, which measured five by three centimeters, was removed from the part of the heart beneath the xiphoid process, the extension of the lowest part of the sternum in the chest. In 13 cases, a sclerosing solution was introduced into the pericardial space to destroy some of the cancerous cells. Two patients died within one month of the procedure. In the remaining cases, pericardial effusions were effectively controlled for at least 30 days; two recurrences were recorded at one and a half and at seven months after the procedure. One patient died of lacerations of the heavily cancerous pericardium. Two patients experienced transient arrhythmias, three developed chest pain from the sclerosing solution, and five developed fever. For advanced cancer patients with clinically symptomatic pericardial effusions, the removal of a portion of the pericardium is a safe and effective means of controlling the malignant effusions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Sclerotherapy, Pericardium, Cardiac tamponade, Pericardiocentesis

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Intraperitoneal OK-432 instillation for the management of malignant pericardial effusion

Article Abstract:

As cancer treatments become more effective, even patients with advanced disease survive for longer periods than in the past. One of the consequences of this lengthened survival is that complications of advanced cancer which were uncommon in the past are becoming more familiar to the cancer specialist. One such complication is malignant pericardial effusion. Cancer cells can get into the narrow space between the heart and its fibrous protective sheath, the pericardium. Presence of these cells can stimulate the collection of fluid in the pericardial space. If enough fluid accumulates, it becomes a cushion which dampens the motion of the heartbeat, reducing its effectiveness; this condition is called cardiac tamponade. The immediate effects of cardiac tamponade due to malignant pericardial effusion may be relieved by puncturing the pericardium and drawing out the excess fluid. However, this procedure alone is not sufficient, since the fluid will simply accumulate again. Many treatment procedures have been attempted to prevent the re-accumulation of fluid in the pericardial space. In a recent study, OK-432 was evaluated in the treatment of 10 patients with malignant pericardial effusion. OK-432 is an unusual material in that it consists entirely of dead germs, more specifically Streptococcus pyogenes A3. These bacteria serve as a potent stimulator of many biological actions, including immune reactions. The injection of these dead bacteria was sufficient to relieve the pericardial effusion in seven patients; the remaining three patients required more than one injection. Effective control of the malignant pericardial effusion was achieved in all patients. Most of the patients, however, died of their uncontrolled advanced cancer. The injection of OK-432 into the pericardial space is a safe and effective method of achieving control of malignant pericardial effusion. The biological mechanisms by which the bacteria achieve this control are not known. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Streptococcus pyogenes

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A Phase I study of a new cisplatin derivative for hematologic malignancies

Article Abstract:

Cisplatin has proved to be an important advance in the chemotherapy of several solid tumors, and research in chemotherapy is attempting to improve the therapeutic effectiveness of this substance. A new cisplatin derivative, called 'DWA 2114R', has been effective in treating solid tumors in Phase I trials, and is now undergoing Phase II trials in Japan. Unfortunately, cisplatin is not effective against hematologic (blood-related) cancers, like leukemia. This is especially disappointing since there are few drugs available to fight leukemia that has failed to respond or has relapsed after standard treatment. The new DWA, however, has shown greater toxicity for the bone marrow cells which give rise to the leukemic cells in some patients. Therefore, a preliminary trial was devised to evaluate DWA in treating patients with hematologic cancer. Eight patients who had relapsed after conventional treatment were started on an intravenous infusion of 800 milligrams of DWA per meter squared of body area over a 24-hour period. This dose, which was based upon experience with solid tumors, was increased to 1,600 milligrams and then dropped back to 1,200 milligrams, which seemed to be the best compromise between effectiveness and toxicity. Diarrhea and vomiting were sufficiently severe to require nutritional support for the patients. Bone marrow toxicity was expected, but was tolerable. Five of the eight patients had acute nonlymphocytic leukemia; one of these entered complete remission following treatment. In addition, one patient with chronic myelogenous leukemia who was in a crisis stage returned to a chronic stage. These results suggest that this compound may have some promise in the treatment of leukemia and should be evaluated in a Phase II trial. (Consumer Summary produced by Reliance Medical Information, Inc.)

Leukemia, Chemotherapy, Platinum compounds

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