Pericardial disease is increasingly recognized in cancer patients, including acute pericarditis, pericardial effusion, and constrictive pericarditis, often indicating a poor prognosis. Acute pericarditis arises from direct tumor involvement, cancer therapies, and radiotherapy. Immune checkpoint inhibitor (ICI)-related pericarditis, though rare, entails significant mortality risk. Treatment includes NSAIDs, colchicine, and corticosteroids or anti-IL1 drugs in refractory cases. Pericardial effusion is the most frequent manifestation, primarily caused by lung cancer, followed by breast cancer, lymphoma, leukemia, gastrointestinal tumors, and melanoma. Chemotherapy, immunotherapy, and radiotherapy may also cause fluid accumulation in the pericardial space. Symptomatic relief for pericardial effusion may require pericardiocentesis, prolonged catheter drainage, or a pericardial window. Instillation of intrapericardial cytostatic agents may reduce recurrence. Constrictive pericarditis, though less common, often develops from radiotherapy and requires multimodality imaging for diagnosis, with pericardiectomy as the definitive treatment. Primary pericardial tumors are rare, with metastases being more frequent. Patients with cancer and pericardial disease generally have poor survival, emphasizing the need for early detection. A multidisciplinary approach involving hematologists, oncologists, and cardiologists is crucial to tailoring pericardial disease treatment to a patient’s clinical status, thereby improving the quality of life and prognosis.
心包疾病在癌症患者中日益受到关注，包括急性心包炎、心包积液和缩窄性心包炎，通常提示预后不良。急性心包炎可由肿瘤直接侵犯、癌症治疗及放射治疗引起。免疫检查点抑制剂相关心包炎虽罕见，但具有显著的死亡风险。治疗包括非甾体抗炎药、秋水仙碱，难治性病例可使用皮质类固醇或抗IL-1药物。心包积液是最常见的表现，主要由肺癌引起，其次为乳腺癌、淋巴瘤、白血病、胃肠道肿瘤和黑色素瘤。化疗、免疫治疗和放疗也可能导致心包腔积液。心包积液的症状缓解可能需要心包穿刺术、延长导管引流或心包开窗术。心包内灌注细胞抑制药物可降低复发率。缩窄性心包炎虽较少见，但常由放射治疗引起，需通过多模态影像学进行诊断，心包切除术是其确定性治疗方法。原发性心包肿瘤罕见，转移性肿瘤更为常见。合并心包疾病的癌症患者总体生存率较差，这强调了早期检测的重要性。由血液科、肿瘤科和心脏科医生组成的多学科协作至关重要，可根据患者临床状况制定个体化心包疾病治疗方案，从而改善生活质量和预后。
Pericardial Disease in Patients with Cancer: Clinical Insights on Diagnosis and Treatment
肿瘤(癌症)患者之家