Review of evolving etiologies, implications and treatment strategies for the superior vena cava syndrome

Abstract

Superior vena cava syndrome (SVCS) is a relatively common sequela of mediastinal malignancies and may cause significant patient distress. SVCS is a medical emergency if associated with laryngeal or cerebral edema. The etiologies and management of SVCS have evolved over time. Non-malignant SVCS is typically caused by infectious etiologies or by thrombus in the superior vena cava and can be managed with antibiotics or anti-coagulation therapy, respectively. Radiation therapy (RT) has long been a mainstay of treatment of malignant SVCS. Chemotherapy has also been used to manage SVCS. In the past 20 years, percutaneous stenting of the superior vena cava has emerged as a viable option for SVCS symptom palliation. RT and chemotherapy are still the only modalities that can provide curative treatment for underlying malignant etiologies of SVCS. The first experiences with treating SVCS with RT were reported in the 1970’s, and several advances in RT delivery have subsequently occurred. Hypo-fractionated RT has the potential to be a more convenient therapy for patients and may provide equal or superior control of underlying malignancies. RT may be combined with stenting and/or chemotherapy to provide both immediate symptom palliation and long-term disease control. Clinicians should tailor therapy on a case-by-case basis. Multi-disciplinary care will maximize treatment expediency and efficacy.

Our therapeutic approach to pregnant patient with superior vena cava syndrom

“…Konvansiyonel olarak steroid kullanımı RT'ye bağlı ödemide azaltır [13] . Biz hastamızda yüksek doz steroid tedavisine anında başladık 6. günde semptomlar rahatladıktan sonra steroid dozunu düştük ve hastamızı RT ve KT'nin birlikte yapıldığı bir merkeze sevk ettik.…”

“…Straka ve ark. 'nın [13] önerdiği algoritmaya göre vena cava süperiora stent yerleştirilmesi düşünülebilirdi.…”

Transcaval core biopsy in malignant superior vena cava obstruction: Potential for single stage diagnosis and treatment

“…Stenting is the accepted approach to urgently treat SVCS and should be offered in those with severe symptoms. It is reliable with efficacy of up to 95% and rapid with symptomatic relief being achieved within 72 hours …”

Thrombosis of the Superior Vena Cava Surrounding Central Venous Catheter in a Patient with Superior Vena Cava Syndrome

“…Superior Vena Cava Syndrome (SVCS) is defined as the set of signs and symptoms derived from superior vena cava obstruction, both intrinsic obstruction and extrinsic compression, which causes an increase in venous pressure in the upper body region [1]. Most frequent clinical manifestations are listed in Table 1.…”

“…In México the first cause of SVCS is the microcytic lung cancer [2]. Around the world the first cause of SVCS as it´s in México is neoplastic, and from these ones the most common is lung cancer [1][2][3].…”