Journal of Clinical Oncology, Vol 14, 3141-3147, Copyright © 1996 by American Society of Clinical Oncology
Prospective comparison of the sclerosing agents doxycycline and bleomycin for the primary management of malignant pericardial effusion and cardiac tamponade
G Liu, M Crump, PE Goss, J Dancey and FA Shepherd
Department of Medicine, Toronto Hospital, Ontario, Canada.
PURPOSE: To compare the clinical efficacy and toxicity of doxycycline and
bleomycin as sclerosing agents in the primary management of malignant
pericardial effusion (MPE). METHODS: Twenty-seven consecutive adult
patients referred to a tertiary-care institution for the management of
cardiac tamponade and malignancy underwent pericardial drainage through a
percutaneously placed pigtail catheter. They were then alternately assigned
to undergo bleomycin or doxycycline pericardial sclerosis. RESULTS: There
were 13 men and 14 women, with a median age of 59 years. They mainly had
lung (70%) and breast cancers (11%), and all had clinical and
echocardiographic evidence of cardiac tamponade. Although all patients had
successfully placed catheters, six were inadvertently dislodged before
sclerosis; 11 underwent bleomycin sclerosis and 10 doxycycline sclerosis.
Twenty patients (one early death) were assessable. One patient in each
group failed to respond to sclerosis with the initial agent, but both were
sclerosed successfully with the other agent. Sclerosis was achieved with a
median of two instillations for each agent and total median doses of
bleomycin 20 mg and doxycycline 1,250 mg. Seventy percent of doxycycline
patients developed significant retrosternal pain, compared with no
bleomycin patients (P = .04). Doxycycline patients required a median of 3.5
more days of hospitalization (8.5 v 5) and 2 more days of pericardial
catheterization (7 v 5) compared with bleomycin patients. Tamponade
recurred in one bleomycin patient at 253 days, and in no doxycycline
patient. CONCLUSION: Although bleomycin and doxycycline are equally
effective sclerosing agents, bleomycin is associated with significantly
less morbidity and should be the first-line chemical sclerosing agent for
malignant pericardial effusions.
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