Diagnostik und therapie maligner pleura- und perikardergusse

Advanced malignant tumors are often associated with malignant pleural and/or pericardial effusions. Since both effusions may be associated with severe dyspnea, immediate removal of the fluid is necessary. However, prevention of recurrence presents a major issue in such patients. To date there are no reliable data in the literature on the optimal management of pleural or pericardial effusions, although numerous approaches, including pleuroectomy/pericardioectomy, radiation therapy, instillation of radioisotopes, or intracavitary application of cytostatic drugs have been proposed. Currently, intrapleural instillation of tetracyclines is the treatment of choice for malignant pleural effusion (response rate: 68-92%). Bleomycin (60 mg) and mitoxantrone (30 mg) should be used as second- and third-line therapy strategies, respectively. In the treatment of malignant pericardial effusions, thiotepa (15 mg, days 1, 3 and 5) appears to be most effective (response rate: 83%). Mitoxantrone (10-20 mg) is equally effective, but increased systemic toxicity has been reported. Since recent studies provided evidence that intrapericardial instillation of 5 mCi ³²P-colloid is even more effective than thiotepa (response rate: 95%), this treatment modality can also be considered for the management of pericardial effusion, if available.