The management of pericardial effusion in cancer patients

The relatively little attention given in the literature to the problem of pericardial effusion in patients with cancer reflects the general attitude that if this complication is disclosed, the future of the patient is sealed, and therapy will not change his outcome. We challenge this pessimistic approach, and describe here our experience with seven patients with solid tumors, in whom pericardial effusion was diagnosed; one of them is described in detail. We advocate an active and sometimes even an aggressive therapy, which should always be related to the degree of the hemodynamic impairment. If instant relief is indicated, pericardiocentesis should be done; pericardiectomy is the treatment of choice if the fluid reaccumulates rapidly. After overcoming the urgent problem, the underlying disease and the local pericardial condition should be treated; and in our opinion, a combined approach, such as systemic or local chemotherapy, or both, with or without precordial irradiation, will lead to the optimal result.