Management of neoplastic pericardial effusions.

AIMS AND BACKGROUND: Malignant pericardial effusion and cardiac tamponade are known complications of many advanced malignancies such as breast cancer, lung cancer, lymphomas and leukemias. Overall survival is low, due to other metastatic localizations. The present study evaluated the clinical outcome and prognosis in patients with advanced cancer with pericardial effusion. METHODS: We studied 7 patients, 4 men and 3 women, with malignant pericardial effusion, affected by breast cancer (2 patients), lung cancer (adenocarcinoma in 3 patients, microcytoma in 1 patient), and B-cell non-Hodgkin lymphoma (1 patient). All patients underwent pericardiocentesis; 3 patients underwent an instillation of thiotepa. RESULTS: One terminal patient treated with pericardiocentesis died after only a few hours. All the remaining patients experienced immediate symptomatic improvement and no operative complications. At the end of the study period, 2 patients were alive at 59 and 33 months, respectively, and 4 died of disease progression at 1 to 32 months (mean, 10.5). CONCLUSIONS: Pericardiocentesis is an active necessary approach, and intrapericardial treatment with thiotepa was able to reduce pericardial effusion and to prevent its reaccumulation. The standard treatment of malignant effusion and cardiac tamponade has not yet been defined. Physicians should consider the status and the prognosis of each case.

Conformal radiotherapy of clinically localized prostate cancer: analysis of rectal and urinary toxicity and correlation with dose-volume parameters.

AIMS AND BACKGROUND: Rectal and urinary toxicities are the principal limiting factors in delivering a high target dose to patients affected by prostate cancer. The verification of such toxicity is an important step before starting a dose-escalation program. The present observational study reports on the acute and late rectal and urinary toxicity in relation with dose-volume parameters in 104 patients with localized prostate cancer treated with 3-dimensional conformal radiation therapy. METHODS AND STUDY DESIGN: One hundred and four patients with stage T1b-T3b prostate cancer were treated with three-dimensional conformal radiation therapy to a total dose of 74 Gy, 2 Gy per fraction. Rigid dose constraints were applied for rectum and bladder. Acute and late rectal and urinary toxicities were analyzed also in relation to dose-volume histograms. Biochemical relapse-free survival was defined according to the American Society of Therapeutic Radiation Oncology (ASTRO) criteria and to the RTOG-ASTRO Phoenix Consensus Conference Recommendations using the Kaplan-Meier method. RESULTS: No grade 3 toxicity was observed. Acute and late grade 2 toxicity rates were 5.8% and 9.0% for rectum and 12.5% and 2.0% for bladder, respectively. Rectal V70 influenced the occurrence of late grade 2 toxicity. A relationship between acute and late urinary toxicity was also found. After a median follow-up of 30 months (range, 20-50), the actuarial overall and biochemical relapse-free survival rates were 84% and 77%, respectively, with a significant difference between low-intermediate and high-risk patients. CONCLUSIONS: Conformal radiotherapy to the dose of 74 Gy was administered with good compliance. The incidence of acute and late toxicity was relatively low in accord with our dose constraints. Rectal V70 proved to be a reliable prognosticator of late toxicity. Overall survival and biochemical relapse-free survival rates were more favorable for low and intermediate-risk and significantly less favorable for high-risk patients.