RESUMEN
BACKGROUND AND PURPOSE: To evaluate radiation modality effects on pericardial effusion (PCE), pleural effusion (PE) and survival in esophageal cancer (EC) patients. MATERIALS AND METHODS: We analyzed data from 470 EC patients treated with definitive concurrent chemoradiotherapy (CRT). Bayesian semi-competing risks (SCR) regression models were fit to assess effects of radiation modality and prognostic covariates on the risks of PCE and PE, and death either with or without these preceding events. Bayesian piecewise exponential regression models were fit for overall survival, the time to PCE or death, and the time to PE or death. All models included propensity score as a covariate to correct for potential selection bias. RESULTS: Median times to onset of PCE and PE after RT were 7.1 and 6.1months for IMRT, and 6.5 and 5.4months for 3DCRT, respectively. Compared to 3DCRT, the IMRT group had significantly lower risks of PE, PCE, and death. The respective probabilities of a patient being alive without either PCE or PE at 3-years and 5-years were 0.29 and 0.21 for IMRT compared to 0.13 and 0.08 for 3DCRT. In the SCR regression analyses, IMRT was associated with significantly lower risks of PCE (HR=0.26) and PE (HR=0.49), and greater overall survival (probability of beneficial effect (pbe)>0.99), after controlling for known clinical prognostic factors. CONCLUSIONS: IMRT reduces the incidence and postpones the onset of PCE and PE, and increases survival probability, compared to 3DCRT.
Asunto(s)
Neoplasias Esofágicas/radioterapia , Derrame Pericárdico/radioterapia , Derrame Pleural/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Teorema de Bayes , Quimioradioterapia , Estudios de Cohortes , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/patología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Derrame Pericárdico/tratamiento farmacológico , Derrame Pericárdico/prevención & control , Derrame Pleural/tratamiento farmacológico , Derrame Pleural/prevención & control , Puntaje de Propensión , Radioterapia Conformacional , Análisis de Regresión , Estudios RetrospectivosRESUMEN
A 47-year-old woman was referred to our hospital because of cardiomegaly and pericardial effusion. She complained of a cough. Computed tomography, echocardiography, and magnetic resonance imaging showed a mass on the pericardium. Exploratory surgery revealed a solid tumor invading the pericardium over the aortic arch and main pulmonary artery. Histological examination indicated primary malignant pericardial mesothelioma. After 58 Gy radiation, the size of the tumor was temporarily reduced and the patient's symptoms disappeared. However, the tumor enlarged and her symptoms reappeared 7 months after temporary improvement. Eighteen months after the development of cough, the patient died suddenly.
Asunto(s)
Neoplasias Cardíacas/radioterapia , Mesotelioma/radioterapia , Pericardio/patología , Femenino , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/patología , Humanos , Imagen por Resonancia Magnética , Mesotelioma/diagnóstico por imagen , Mesotelioma/patología , Persona de Mediana Edad , Derrame Pericárdico/radioterapia , Dosificación Radioterapéutica , Tomografía Computarizada por Rayos XRESUMEN
Chronic pericardial effusions are a major cause of morbidity in some clinical settings. Although the treatment of choice for acute symptomatic pericardial effusions (tamponade) is pericardiocentesis, the long-term management of symptomatic chronic pericardial effusions provides a greater challenge. The aim of this review is to provide insight into the presentation,diagnosis, and different treatment options available to patients with chronic symptomatic pericardial effusions,with emphasis on malignant pericardial effusions. Peri-cardiocentesis with sclerosing agents, radiation therapy,percutaneous, and surgical pericardiotomy and other surgical techniques are particularly efficacious, depend-ing on the underlying cause and the patient's prognosis.
Asunto(s)
Derrame Pericárdico/diagnóstico , Derrame Pericárdico/terapia , Oclusión con Balón , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/terapia , Cateterismo , Catéteres de Permanencia , Enfermedad Crónica , Drenaje , Humanos , Derrame Pericárdico/etiología , Derrame Pericárdico/radioterapia , Derrame Pericárdico/cirugía , Pericardiectomía/métodos , Pericardiocentesis , Escleroterapia/métodosRESUMEN
Malignant pericardial effusion is usually treated only when signs of cardiac tamponade develop. Several methods of treatment have been reported with an overall response rate of approximately 75%. Since our initial study using intrapericardial 32P-colloid instillation as a treatment modality for pericardial effusion demonstrated a significant higher response rate, this study was conducted to further evaluate the efficacy of intrapericardial 32P-colloid in terms of response rates and duration of remissions. Intrapericardial instillation of 185-370 MBq (5-10 mCi) 32P-colloid in 36 patients with malignant pericardial effusion resulted in a complete remission rate of 94.5% (34 patients) whereas two patients did not respond to treatment due to a foudroyant formation of pericardial fluid. The median duration time was 8 months. No side-effects were observed. These results suggest that intrapericardial instillation of 32P-colloid is a simple, reliable and safe treatment strategy for patients with malignant pericardial effusions. Therefore, since further evidence is provided that 32P-colloid is significantly more effective than external radiation or non-radioactive sclerosing agents, this treatment modality should be considered for the management of malignant pericardial effusion.
Asunto(s)
Compuestos de Cromo/uso terapéutico , Neoplasias/patología , Derrame Pericárdico/radioterapia , Radioisótopos de Fósforo/uso terapéutico , Radiofármacos/uso terapéutico , Neoplasias de la Mama/patología , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/fisiopatología , Femenino , Neoplasias Gastrointestinales/patología , Humanos , Instilación de Medicamentos , Neoplasias Pulmonares/patología , Linfoma/patología , Neoplasias/complicaciones , Neoplasias/radioterapia , Derrame Pericárdico/etiología , Radiofármacos/administración & dosificaciónRESUMEN
The method of intrapleural Mitoxantrone therapy in case of metastasizing mammary cancer is presented in form of a case report. The uncomplicated procedure, the high rate of remission and the few side effects are the advantages as compared to other methods of pleurodesis. Mitoxantrone could cause an intrapleural inflammatory reaction. That is supported by the cytologic findings before and after the therapy.
Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/radioterapia , Carcinoma Intraductal no Infiltrante/tratamiento farmacológico , Mitoxantrona/administración & dosificación , Derrame Pericárdico/tratamiento farmacológico , Derrame Pericárdico/radioterapia , Derrame Pleural Maligno/tratamiento farmacológico , Derrame Pleural Maligno/radioterapia , Neoplasias de la Mama/patología , Carcinoma Intraductal no Infiltrante/patología , Carcinoma Intraductal no Infiltrante/radioterapia , Terapia Combinada , Femenino , Humanos , Inyecciones Intralesiones , Mitoxantrona/efectos adversos , Estadificación de Neoplasias , Derrame Pericárdico/patología , Pericardio/efectos de los fármacos , Pericardio/patología , Pericardio/efectos de la radiación , Pleura/efectos de los fármacos , Pleura/patología , Pleura/efectos de la radiación , Derrame Pleural Maligno/patología , Traumatismos por Radiación/patologíaRESUMEN
A 68-yr-old male with agnogenic myeloid metaplasia was given phosphorus-32-colloidal chromic phosphate intrapericardially for the treatment of malignant pericardial effusion. Technetium-99m-sulfur colloid was used to verify catheter placement and to visualize distribution within the pericardium. Estimated dosimetry for this mode of therapy is presented, and it is suggested that pericardial administration of phosphorus-32-colloidal chromic phosphate is the treatment of choice for malignant pericardial effusion.
Asunto(s)
Compuestos de Cromo , Derrame Pericárdico/radioterapia , Radioisótopos de Fósforo/uso terapéutico , Anciano , Cromo/administración & dosificación , Coloides , Humanos , Masculino , Derrame Pericárdico/etiología , Fosfatos/administración & dosificación , Radioisótopos de Fósforo/administración & dosificación , Mielofibrosis Primaria/complicacionesRESUMEN
Malignant pericardial effusions that are not causing tamponade can be effectively treated by external beam irradiation--a readily available non-invasive treatment. In a consecutive series six out of eight patients achieved good palliation of their effusions as a result of this treatment.
Asunto(s)
Derrame Pericárdico/radioterapia , Adulto , Anciano , Neoplasias de la Mama/complicaciones , Femenino , Humanos , Neoplasias Pulmonares/complicaciones , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Derrame Pericárdico/etiologíaRESUMEN
Malignant pericardial effusion secondary to pericardial metastases from gynecological malignancies represents an infrequent but potentially life threatening problem. A patient with recurrent squamous cell carcinoma of the cervix causing symptomatic pericardial effusion is presented, and the incidence, mechanism, pathophysiology, treatment, and outcomes of malignant pericardial effusion in patients with gynecologic malignancies are reviewed. This case represents only the fourth reported patient with metastatic carcinoma of the cervix in whom the diagnosis of malignant pericardial effusion was made antemortem, and is the longest survivor of treatment. Gratifying results, in terms of improved quality and length of survival, can be obtained in what is often perceived as a preterminal complication. Recommendations for management are presented, stressing radiation therapy and other local measures following initial pericardiocentesis.
Asunto(s)
Carcinoma de Células Escamosas/secundario , Neoplasias Cardíacas/secundario , Derrame Pericárdico/etiología , Pericardio , Neoplasias del Cuello Uterino , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/radioterapia , Femenino , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/radioterapia , Humanos , Persona de Mediana Edad , Derrame Pericárdico/radioterapia , Dosificación RadioterapéuticaAsunto(s)
Taponamiento Cardíaco/terapia , Neoplasias Cardíacas/complicaciones , Derrame Pericárdico/terapia , Neoplasias de la Mama , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Drenaje , Urgencias Médicas , Femenino , Neoplasias Cardíacas/fisiopatología , Neoplasias Cardíacas/secundario , Humanos , Neoplasias Pulmonares , Derrame Pericárdico/etiología , Derrame Pericárdico/radioterapia , Pericardio/cirugía , Tetraciclina/administración & dosificaciónRESUMEN
Tumour-associated monoclonal antibodies (HMFG1, HMFG2 and AUA1) radiolabelled with iodine-131 were given intracavitary (intrapleurally and intrapericardially) to patients with malignant effusions. Ten out of 13 effusions (3 pericardial and 7 pleural) responded completely with no fluid reaccumulation between 3 and 18 months. No clinical or other toxicity was observed. This new method of treatment for recurrent malignant effusions is non-toxic and effective resulting in improved quality of life, and, in some cases, prolongation of survival.
Asunto(s)
Anticuerpos Monoclonales/administración & dosificación , Radioisótopos de Yodo/uso terapéutico , Derrame Pericárdico/radioterapia , Derrame Pleural/radioterapia , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Derrame Pericárdico/etiología , Derrame Pleural/etiología , Dosificación RadioterapéuticaRESUMEN
Treatment of 11 patients with malignant pericardial effusion was performed by instillation of radioactive phosphorus. All of these patients had clinical evidence of tamponade. Only 2 patients had further problems with effusion after radioisotope therapy. Remarkable long-lasting remission could be observed in the rest of patients.
Asunto(s)
Neoplasias Cardíacas/radioterapia , Derrame Pericárdico/radioterapia , Radioisótopos de Fósforo/uso terapéutico , Adulto , Taponamiento Cardíaco/etiología , Femenino , Neoplasias Cardíacas/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico/etiologíaRESUMEN
Treatment of 28 patients with malignant pericardial effusion was accomplished primarily by intrapericardial instillation of radioactive chromic phosphate. At time of diagnosis of pericardial disease, 14 patients had major manifestations of tamponade; the rest had little or no clinical evidence of effusion. Only eight of the 28 patients had further problems with effusion after the initial pericardiocentesis and 32P instillation. Additional aspirations were done on those patients 2 weeks to 5 months later. The average survival was 9 months; seven patients lived more than 1 year.
Asunto(s)
Neoplasias/complicaciones , Derrame Pericárdico/radioterapia , Radioisótopos de Fósforo/administración & dosificación , Adulto , Anciano , Cateterismo , Cromo/administración & dosificación , Cromo/uso terapéutico , Femenino , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Derrame Pericárdico/etiología , Derrame Pericárdico/mortalidad , Radioisótopos de Fósforo/uso terapéuticoAsunto(s)
Taponamiento Cardíaco/etiología , Prótesis Valvulares Cardíacas , Derrame Pericárdico/radioterapia , Adulto , Taponamiento Cardíaco/radioterapia , Cardiomegalia/diagnóstico por imagen , Femenino , Humanos , Válvula Mitral/cirugía , Derrame Pericárdico/complicaciones , Derrame Pericárdico/etiología , Complicaciones Posoperatorias/radioterapia , Radiografía , Válvula Tricúspide/cirugíaRESUMEN
This paper reports a unique case of malignant pericardial effusion secondary to metastatic mucoepidermoid carcinoma in a patient who previously had mucoepidermoid carcinoma of the parotid gland and subsequently was found to have a hypernephroma of the kidney. Its distinctive features warranted the diagnosis of mucoepidermoid carcinoma as the cause of the effusion, and excluded the more aggressive hypernephroma. Although pericardectomy was ultimately necessary, there was no evidence of viable malignancy in fluid specimens obtained after an initial course of radiation therapy or in the resected pericardium. This suggests that conservative treatment with local radiation therapy might be successful in future cases of pericardial effusion in this malignancy.