Long-term Results of Intrapericardial Chemotherapeutic Treatment of Malignant Pericardial Effusions With Thiotepa* Alessandro Martinoni, MD; Carlo Maria Cipolla, MD; Daniela Cardinale, MD; Maurizio Civelli, MD; Giuseppina Lamantia, MD; Marco Colleoni, MD; and Cesare Fiorentini, MD Objective: Pericardial involvement is a common feature in different neoplastic diseases, having a strong influence on the natural history of the disease and on the quality of life of the patients. This study was performed in order to investigate the long-term effects of intracavitary treatment with thiotepa in the reduction of pericardial effusion (PE) recurrences. Design: Prospective controlled intervention study. Setting: European Institute of Oncology, Milan, Italy. Patients: We studied 33 patients, 15 men and 18 women, with malignant PE, who were affected by breast cancer (11 patients), lung cancer (16 patients), microcytoma (4 patients), endometrial cancer (1 patients), and melanoma (1 patient). Intervention: All patients with large PE, with or without cardiac tamponade, underwent percutaneous pericardiocentesis (PC) under echocardiographic monitoring. Patients with neo- plastic cells in drained fluid were considered to be eligible for treatment. After drainage, the catheter was maintained in the pericardial sac for the instillation of a sclerosing, alkylating antiblastic agent (thiotepa) on days 1, 3, and 5 after the PC (15 mg at each step). Results: No procedure-related complications or side effects were observed. Two patients died because of disease progression, without PE evidence. No PE occurred in the remaining patients during the first month. Three recurrences occurred (9.1%), requiring additional PC and intrapericardial treatment. The median survival time was 115 days (range, 22 to 1,108 days) in the overall population, and 272 days in patients with breast cancer. Conclusions: Intrapericardial treatment with thiotepa carries a minimal risk and is a repeatable procedure that can dramatically increase quality of life, or even can improve survival and the natural history of disease in cancer patients. (CHEST 2004; 126:1412–1416) Key words: antineoplastic agents; cardiac tamponade; neoplasms; pericardial effusion; thiotepa Abbreviations: NSCLC = non-small cell lung cancer; PC = pericardiocentesis; PE = pleural effusion P ericardial diseases and pericardial involvement are an increasingly common complication of neoplastic diseases, which can be life-threatening not only in patients with unresponsive or aggressive terminal malignancies, but also in patients with otherwise favorable prognoses. Early and successful therapy for patients with pericardial disease is therefore crucial in significantly increasing life expectancy, or in improving palliation *From the Cardiology Unit (Drs. Martinoni, Cipolla, Cardinale, Civelli, Lamantia, and Fiorentini) and Medical Oncology Divi- sion (Dr. Colleoni), European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, University of Milan, Milan, Italy. Manuscript received July 9, 2003; revision accepted May 27, 2004. Reproduction of this article is prohibited without written permis- sion from the American College of Chest Physicians (e-mail: permissions@chestnet.org). Correspondence to: Alessandro Martinoni, MD, Cardiology Unit, Via Ripamonti 435, Milan, Italy; e-mail: martinoni@tin.it clinical investigations 1412 Clinical Investigations