Intrapericardial corticosteroid therapy in cancer patients requiring repeated pericardiocentesis
N Lee, H Park, G H Choi, J Y Cho, H J Yoon, K H Kim, Y AhnAbstract
Background/Introduction
Pericardial effusion (PE) is common and distressing complication in patients with advanced cancer. While pericardiocentesis (PCC) provides immediate relief, residual pericardial inflammation often leads to constrictive physiology (CP). This subsequent CP can cause heart failure (HF) symptoms and interrupt systemic anticancer treatment, significantly compromising patient prognosis. Although systemic corticosteroids may alleviate inflammation, their use in cancer patients is often restricted due to risks of systemic adverse effects, including infection, muscle weakness, and metabolic derangements. Intrapericardial corticosteroid (IPC) therapy offers a targeted approach to suppress local inflammation while minimizing systemic toxicity.
Purpose
This study aimed to evaluate the efficacy and safety of IPC therapy with triamcinolone in advanced cancer patients undergoing repeated PCC.
Methods
In this single-centre, prospective pilot cohort study (March 2022 – July 2025), we enrolled 22 patients with stage IV malignancies requiring two or more PCC procedures. The IPC group (n=10) received 200 mg of triamcinolone acetonide instilled into the pericardial space via a pigtail catheter after complete drainage. The control group (n=12) received standard PCC. The primary outcome was a composite of all-cause death, worsening HF (hospitalisation or unplanned visits), cancer treatment interruption due to HF, and repeat PCC after the index procedure. Secondary outcomes included the individual components, serial changes of C-reactive protein (CRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, procedure-related complications, and hospitalisation duration.
Results
During a median follow-up of 172.5 days (interquartile range [IQR], 57.0-543.0), the primary outcome occurred in 4 (40.0%) patients in the IPC group versus 12 (100.0%) patients in the control group (hazard ratio [HR] 0.20; 95% confidence interval [CI], 0.07-0.58; P = 0.003). All-cause mortality was significantly lower in the IPC group (20.0% vs. 100.0%). Notably, no patients in the IPC group experienced worsening HF or cancer treatment interruption due to HF, whereas these were observed exclusively in the control group. Median survival from the index procedure was significantly longer in the IPC group (104.5 days; IQR, 37.0-176.0) compared to the control group (26.0 days; IQR, 7.5-60.5). No major procedure-related complications occurred in the IPC group. Although not statistically significant, CRP and NT-proBNP levels showed more favourable downward trends in the IPC group, indicating better inflammatory control.
Conclusions
IPC therapy with triamcinolone appears to be a safe and effective treatment option for advanced cancer patients requiring repeated PCC, potentially improving survival and clinical outcomes without increasing procedural risks. Further large-scale studies are warranted to confirm these promising pilot results.Composite primary outcome Trajectories of CRP and NT-proBNP