Vascular Stenting for Palliation of Superior Vena cava Obstruction in Non-Small-Cell Lung Cancer Patients: A Future ‘Standard’ Procedure?

Greillier, L.; Doddoli, Christophe; Durieux, Olivier; Torré, Jean-Philippe; Gimenez, C.; Kleisbauer, J P

doi:10.1159/000076681

Cited by 35 publications

(33 citation statements)

References 21 publications

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“…In 76.5% of all patients with relapse, stent patency could be restored by thombolysis or further stent insertion. The effectiveness of SVC stenting in case of obstruction due to malignant tumours was confirmed in several more recently performed studies with similar results [68,69,70]. …”

Section: Svc Syndromesupporting

confidence: 57%

Advanced Malignant Lung Disease: What the Specialist Can Offer

Gompelmann

Eberhardt

Herth³

2011

Respiration

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Lung cancer is not only the most commonly diagnosed cancer worldwide, but it is still the leading cause for cancer-related death. The 5-year survival for lung cancer in Europe and in the USA is totally 16%. Therefore, a palliative therapy regimen is required to control the disease and reduce symptoms with the objective of enhancing quality of life of lung cancer patients. In addition to chemotherapy that is still one of the most important pillars in the treatment of advanced lung cancer, further interventional strategies can be offered to improve a patient’s quality of life. A locoregional tumour progression is frequently associated with malignant pleural effusion or pericardial effusion, central airway obstruction, tracheo-oesophageal fistula, severe haemoptysis or superior vena cava (SVC) syndrome threatening life and necessitating urgent palliation. Recurrent pleural effusion causing dyspnoea can be managed by pleurodesis, serial thoracocentesis or insertion of an indwelling catheter. Symptomatic malignant pericardial effusion often requires an urgent pericardiocentesis. Furthermore, surgical procedures, instillation of sclerosing agents or local chemotherapy should be considered in refractory pericardial effusion. The therapy regimen of central airway stenosis includes mechanical and thermic endoscopic procedures providing rapid relief of symptoms. To prevent recurrence of airway obstruction, the insertion of a stent or palliative brachytherapy provide re-establishment of the patency of obstructed airways. Haemoptysis can be managed by bronchoscopic interventions as well as by arterial embolization or palliative thoracic radiotherapy. The therapy of SVC syndrome is dependent of histology. In small-cell lung cancer, chemotherapy is recommended. In non-small-cell lung cancer, stent insertion and/or radiotherapy are the therapeutic pillars.

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Section: Svc Syndromesupporting

confidence: 57%

Advanced Malignant Lung Disease: What the Specialist Can Offer

Gompelmann

Eberhardt

Herth³

2011

Respiration

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“…Most studies report a recurrence rate of up to 25% but figures up to 33% to 41% have also been reported. 2,[20][21][22][23][24][25][26][27] A recent review article has studied complication rates after SVC stenting. 2 In a total of 884 stent placements in 32 studies, the mortality was 2%, which is similar to that in this study.…”

Section: Discussionmentioning

confidence: 99%

Endovascular stenting in the management of malignant superior vena cava obstruction: comparing safety, effectiveness, and outcomes between primary stenting and salvage stenting

et al. 2015

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Objective: To compare the safety, effectiveness, and outcomes of primary stenting and salvage stenting for malignant superior vena cava obstruction. Design: Case series with internal comparison.Setting: Regional hospital, Hong Kong. Patients:A total of 56 patients with malignant superior vena cava obstruction underwent 59 stentings from 1 May 1999 to 31 January 2014. Patients' characteristics, procedural details, and outcomes were retrospectively reviewed. Of the 56 patients, 33 had primary stenting before conventional therapy and 23 had salvage stenting after failure of conventional therapy. Statistical analyses were made by Fisher's exact test and Mann-Whitney U test.Results: Primary lung carcinoma was the most common cause of malignant superior vena cava obstruction (primary stenting, 22 patients; salvage stenting, 16 patients; P=0.768), followed by metastatic lymphadenopathy. Most patients had superior vena cava obstruction only (primary stenting, 16 patients; salvage stenting, 15 patients; P=0.633), followed by additional right brachiocephalic vein involvement. Wallstents (Boston Scientific, Natick [MA], US) were used in all patients. Technical success was achieved in all but two patients, one in each group (P=1.000). Only one stent placement was required in most patients (primary stenting, 28 patients; salvage stenting, 20 patients; P=0.726). Procedure time was comparable in both groups (mean time: primary stenting, 89 minutes; salvage stenting, 84 minutes; Endovascular stenting in the management of malignant superior vena cava obstruction: comparing safety, effectiveness, and outcomes between primary stenting and salvage stenting New knowledge added by this study • Endovascular stenting is safe and effective for relieving malignant superior vena cava obstruction (SVCO) in both primary stenting and salvage stenting settings.• Direct comparison between primary stenting and salvage stenting for safety, effectiveness, and outcomes of superior vena cava (SVC) stenting showed no significant differences in number of stents required, success rates, procedure times, symptom relief rates, complication rates, and re-procedure rates between the two groups. Implications for clinical practice or policy • Primary SVC stenting should be considered for patients at their initial presentation with SVCO before conventional therapy by radiotherapy and/or chemotherapy.• Salvage SVC stenting remains a safe and effective treatment for patients with SVCO after failure of radiotherapy and/or chemotherapy.

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“…High doses of corticosteroids are commonly used as adjunctive treatment, but are of unproven benefit [8, 14]. Palliative vascular stenting provides rapid relief of symptoms in 85–100% of cases and is the preferred first line of palliation where this modality is available [15,16,17,18]. Stenting has, however, not been directly compared to radiotherapy in a prospective trial.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Radiological Grading of Superior Vena Cava Obstruction

Plekker

Ellis²,

Irusen³

et al. 2007

Respiration

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Background: Superior vena cava obstruction (SVCO) is commonly caused by neoplastic venous compression and presents with typical symptoms and signs. Its clinical severity presumably depends on the degree of obstruction and the adequacy of venous collateral formation. Objectives: The development of novel clinical and radiological scoring systems based on the postulate that a reproducible relationship exists between the degree of SVCO, the presence of collateral circulation and the extent of clinical symptoms. Methods: We prospectively evaluated consecutive cases of acute and subacute SVCO with a newly developed clinical scoring system, which is based on easily detectable clinical symptoms and signs of SVCO. In parallel, we recorded and scored the degree of SVCO and the extent of collaterals visible on contrast-enhanced computed tomography (CT). Results: Thirty-four cases of SVCO were evaluated: 8 (23.5%) were clinically mild, 16 (47%) moderate and 10 (29.5%) severe. Lung cancer was the underlying histological diagnosis in 94% of cases. Radiologically, 53% had complete SVCO. A well-developed collateral system was found in 14 (41%). A scoring system subtracting a ‘collateral score’ from an ‘obstruction score’ showed a significant correlation with the clinical score (r = 0.75, p < 0.01). Conclusions: Clinical severity of SVCO depends upon the degree of SVCO and is ameliorated by collateral formation. The novel clinical scoring system can predict the underlying CT features in SVCO and may be valuable in the bedside assessment of SVCO severity.

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Vascular Stenting for Palliation of Superior Vena cava Obstruction in Non-Small-Cell Lung Cancer Patients: A Future ‘Standard’ Procedure?

Cited by 35 publications

References 21 publications

Advanced Malignant Lung Disease: What the Specialist Can Offer

Advanced Malignant Lung Disease: What the Specialist Can Offer

Endovascular stenting in the management of malignant superior vena cava obstruction: comparing safety, effectiveness, and outcomes between primary stenting and salvage stenting

Clinical and Radiological Grading of Superior Vena Cava Obstruction

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