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Article
February 27, 1987

Management of Malignant Pericardial Effusion and Tamponade

Author Affiliations

From the Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine and the Fred Hutchinson Cancer Research Center, Seattle.

From the Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine and the Fred Hutchinson Cancer Research Center, Seattle.

JAMA. 1987;257(8):1088-1092. doi:10.1001/jama.1987.03390080078037
Abstract

THE OPTIMAL management of neoplastic cardiac tamponade has been controversial, with ardent proponents of pericardiocentesis (with or without sclerotherapy),1-3 surgical decompression,4-8 and radiation therapy9-11 as primary therapeutic modalities. In the eight years since this oncologic emergency was last reviewed in this journal,12 several informative therapeutic trials have been reported that warrant a reappraisal of the recommended interventions for this condition.

Epidemiology  Although neoplastic involvement of the heart is commonly regarded as a rare condition, a compilation of autopsy series suggests that 3.4% (642/19130) of general autopsies13-18 and 11.6% (1280/11078) of cancer autopsies13-21 demonstrate cardiac metastatic disease. Of 770 cases of cardiac metastases for which adequate information was reported, 533 (69.2%) had involvement of the pericardium.13-16,19,21 The majority of cases were clinically insignificant; however, 29% of such patients developed symptoms referable to pericardial metastases and 16% developed cardiac tamponade.22 Pericardial lesions were either

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