Intrapericardial corticosteroid therapy for recurrent malignant pericardial effusion: a case series

Malignant pericardial effusion (PE) and subsequent effusive-constrictive pericarditis (ECP) are significant clinical challenges in patients with advanced cancer. We report three patients with metastatic breast or lung cancer who experienced recurrent, life-threatening cardiac tamponade despite multiple pericardiocenteses (PCC) and systemic anti-inflammatory treatment (AIT). In all cases, pericardial disease recurred despite conventional management, while chronic systemic corticosteroid use led to debilitating adverse effects. Following complete drainage of the PE, a single high-dose bolus of 200 mg triamcinolone was administered via an intrapericardial catheter with a 12-h clamping protocol. This intervention was associated with sustained pericardial stabilization for 8 to 47 months across all three patients. Pericardial stabilization was maintained despite subsequent progression of the underlying malignancy. In this case series, high-dose (200 mg) intrapericardial corticosteroid therapy may represent a feasible therapeutic option for selected patients with recurrent malignant PE after prior PCC when systemic AIT is ineffective or poorly tolerated.