長期予後を期待した肺癌の癌性心膜炎に対する心膜開窓術と集学的治療

Pericardial Fenestration and Multidisciplinary Treatment to Improve the Prognosis of the Malignant Pericarditis Due to Lung Cancer

肺癌の診療において，患者のパフォーマンスステータス（PS）や生活の質（QOL）を著しく低下させる癌性心膜炎に対する緊急処置とその後の治療マネジメントへの精通は必須である．われわれは，肺癌に併発した癌性心膜炎に対し心膜開窓を含めた集学的治療が奏効し，予後を延長することができた3例を経験したので，文献的考察を加えて報告する．

We experienced 3 cases in whom multidisciplinary treatment with pericardial fenestration was effective for malignant pericardial effusion associated with lung cancer.

Case 1：Right upper lobectomy for lung adenocarcinoma, EGFR （－） and ALK （－） had been performed. After 34 months, malignant pericarditis occurred and left pericardial fenestration was performed. After fenestration, anticancer drugs and immune checkpoint inhibitor （ICI） were administered. He died of lung cancer in 53 months after fenestration.

Case 2：Thirty-three months after left upper lobectomy for lung adenocarcinoma ［EGFR （＋） and ALK （－）］, malignant pleuritis and pericarditis occurred and right pericardial fenestration was performed. After fenestration, anticancer drugs, EGFR-TKI and ICI were administered. He died of lung cancer in 35 months after fenestration.

Case 3：Pericardial fenestration was performed for malignant pericarditis due to lung adenocarcinoma with EGFR （－）, ALK （－） and PD-L1 ［tumor propotion score （TPS） 0％］. After fenestration, anticancer drugs and ICI were administered. The patient died of lung cancer in 15 months after fenestration.

Pericardial fenestration for malignant pericarditis is possibly useful for the management of patients, which in turns is also useful in continuing the medical treatment to prolong the prognosis.