Would you recommend cardiac radiotherapy for malignant pericardial effusion refractory to pericardial fenestration?

Yes. I have done this several times and have gotten some reasonable palliative responses. Typically one cannot determine the exact source for the malignant cells, and one presumes that there are tumor deposits throughout the pericardium, in which case the target is the whole heart. This then limits the doses one can deliver safely, and obviously histology matters. So, for an epithelial tumor (lung or breast is when I have done this), I have given about 150 cGy x (15-17 fractions) = 2250- 2550. If there is a gross nodal mass/primary mass invading the pericardial area, and you want a longer degree of palliation, one can consider boosting that area. Alternatively, in cases with a gross nodal mass/primary mass invading the pericardial area, one...