Malignant pericardial effusion in breast cancer: Terminal event or treatable complication?

Background: Few data are available on malignant pericardial effusion (MPCE) in breast cancer. We identify the patient prone to develop MPCE, describe the result of surgical management, and try to identify a subgroup of patients who do not benefit from surgical management. Method: We performed an audit of our policy of active search for MPCE in breast cancer patients and its treatment by subxiphoid pericardial fenestration. Result: Nineteen patients with MPCE had a mean of 3.2 other sites of recurrence; 17 had pleural recurrence. Six patients had exertional dyspnea and 13 had dyspnea at rest; three needed emergency pericardiocentesis. An average of 740 ml of fluid was recovered; cytology was diagnostic in 11 cases and histopathology in 10 cases. At discharge, six patients had no dyspnea and six had exertional dyspnea. Of 10 patients who did not receive systemic treatment, eight died within 30 days. Nine patients who received systemic treatment had an average survival of 8.3 months. Conclusions: Patients with pleural recurrence presenting with dyspnea should be evaluated for the presence of a MPCE. Subxiphoid pericardial fenestration is the treatment of choice. Patients who will not receive systemic treatment should be managed conservatively. (C) 1997 Wiley-Liss, Inc.