Volume 6, Number 27; September 15, 2006

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Unique Identifier [PMID]: 12555872

Authors: Rowell NP. Gleeson FV.

Institution: Kent Oncology Centre, Maidstone Hospital, Hermitage Lane, Maidstone, Kent ME16 9QQ, UK. nrowell@mkoc.demon.co.uk

Title: Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus: a systematic review. [Review] [107 refs]

Source: Clinical Oncology (Royal College of Radiologists). 14(5):338-51, 2002 Oct.

Abstract: OBJECTIVE: To conduct a systematic review to determine the relative effectiveness of treatments currently employed in the management of superior vena caval obstruction (SVCO). SEARCH STRATEGY: Electronic searching of the Cochrane Clinical Trials Register, Medline and Embase with identification of further studies from references cited in trials identified by electronic searching. SELECTION CRITERIA: Both randomized and non-randomized controlled trials in which patients with carcinoma of the bronchus and SVCO had been treated with any combination of steroids, chemotherapy, radiotherapy OR insertion of an expandable metal stent. DATA COLLECTION AND ANALYSIS: There were three randomized and 98 non-randomized studies of which two and 44 respectively met the inclusion criteria. MAIN RESULTS: Superior vena caval obstruction was present at diagnosis in 10.0% of patients with small cell lung cancer (SCLC) and 1.7% of patients with non-small cell lung cancer (NSCLC). In one small randomized trial in SCLC, the rate of SVCO relapse was not significantly reduced by giving radiotherapy on completion of chemotherapy. In another, in NSCLC, the addition of induction chemotherapy to a course of synchronous chemo-radiotherapy did not provide greater relief of SVCO. In SCLC chemotherapy and/or radiotherapy relieved SVCO in 77%; 17% of those treated had a recurrence of SVCO. In NSCLC, 60% had relief of SVCO following chemotherapy and/or radiotherapy; 19% of those treated had a recurrence of SVCO. Insertion of an SVC stent relieved SVCO in 95%; 11% of those treated had further SVCO but recanalization was possible in the majority resulting in a long-term patency rate of 92%. Morbidity following stent insertion was greater if thrombolytics were administered. REVIEWERS' CONCLUSIONS: Chemotherapy and radiotherapy are effective in relieving SVCO in a proportion of patients whilst stent insertion may provide relief in a higher proportion and more rapidly. The effectiveness of steroids and the optimal timing of stent insertion (whether at diagnosis OR following failure of other modalities) remain uncertain. [References: 107]

Publication Type: Journal Article. Review.

Link Directly to Fulltext Article at Publisher

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Unique Identifier [PMID]: 11907745

Authors: Smayra T. Otal P. Chabbert V. Chemla P. Romero M. Joffre F. Rousseau H.

Institution: Service Central de Radiologie, CHR Rangueil, Toulouse, France.

Title: Long-term results of endovascular stent placement in the superior caval venous system.

Source: Cardiovascular & Interventional Radiology. 24(6):388-94, 2001 Nov-Dec.

Abstract: PURPOSE: To present the long-term results in superior caval stenting for symptomatic obstruction. METHODS: Forty-nine stents were placed in 30 patients: 16 (53%) with malignant lesions, five (17%) with benign lesions and nine (30%) hemodialysis patients. Self-expandable stents were deployed on a first-line basis. Patients were followed clinically as well as by various imaging techniques and survival analysis was performed. RESULTS: Stent deployment was possible in all cases. Reocclusion was seen in 13 patients, of whom eight belonged to the hemodialysis group. Primary and secondary patency rates for malignant, benign and hemodialysis patients were respectively 74%, 50% and 22%, and 74%, 75% and 56% at 1 year. We had 7% complications and one death from iatrogenic superior vena cava injury. CONCLUSION: Primary stenting of superior caval obstruction is a first-choice treatment method achieving good mid-term patency. Patients with hemodialysis shunts must be closely monitored for early reintervention.

Publication Type: Journal Article.

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Unique Identifier [PMID]: 7642434

Authors: Wurschmidt F. Bunemann H. Heilmann HP.

Institution: Hermann-Holthusen-Institut fur Strahlentherapie, Hamburg, Germany.

Title: Small cell lung cancer with and without superior vena cava syndrome: a multivariate analysis of prognostic factors in 408 cases.

Source: International Journal of Radiation Oncology, Biology, Physics. 33(1):77-82, 1995 Aug 30.

Abstract: PURPOSE: Patients with small cell lung cancer (SCLC) and superior vena cava syndrome (SVCS) are widely believed to have a grave prognosis. The purpose of this study was to determine the prognosis of patients with SCLC and SVCS as compared to SCLC without SVCS. METHODS AND MATERIALS: A retrospective analysis of 408 cases of SCLC +/- SVCS was performed. Three- hundred and sixty showed no clinical signs of SVCS and 43 (11%) had SVCS; in 5 patients no adequate information was available about clinical signs of SVCS. All patients were classified as limited disease cases. About 98% received chemotherapy usually as the first treatment followed by radiotherapy. A median total dose of 46 Gy (range 30 to 70 Gy) was given at 2.0 Gy per fraction five times weekly. A prophylactic cranial irradiation was applied if a complete remission was achieved after chemotherapy OR after 30 Gy of irradiation. Kaplan-Meier survival curves are shown and comparisons were made by the log-rank and the Gehan/Wilcoxon test. To adjust for prognostic factors, a proportional hazards analysis was done. RESULTS: Patients without SVCS had 5-year survival rates ( +/- SE) and a median survival time (MST; 95% confidence intervals) of 11% +/- 2% and 13.7 months (12.7-14.5) in UICC Stage I to III; in Stage III the figures were 9% +/- 2% and 12.6 months (11.2-13.7). In comparison, SCLC with SVCS had 5-year survival rates of 15% +/- 7% and MST of 16.1 months (13.8-20.5). The difference was significant in univariate analysis (Stage II disease: p = 0.008 by the log-rank test). In a multivariate analysis of all patients, Stage (Stage I + II > III; p = 0.0003), SVCS (yes > no; p = 0.005), and Karnofsky performance status ( < OR = 70 < 80-100%; p = 0.008) were of significant importance. CONCLUSIONS: SVCS is a favorable prognostic sign in SCLC. The treatment should be curatively intended.

Publication Type: Journal Article.

Resident Report / Department of Medicine & Grady Branch Library

Emory University School of Medicine

2006 Edition

Participating Faculty:  Carlos Del Rio MD  / Joyce Doyle MD / Lorenzo Difrancesco MD / Joel Mermis MD / Maunank Shah MD

Contact: Karl Woodworth