1
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Xiu W, Guo X, Yu M, Li Y, Xu Y, Zhu J, Luo J. Combination of Palliative Thoracic Radiotherapy With Bevacizumab for Stage IV Nonsquamous NSCLC: Is There Any Impact of Time Interval on Survival? Clin Med Insights Oncol 2022; 16:11795549221106462. [PMID: 35770233 PMCID: PMC9234832 DOI: 10.1177/11795549221106462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The time interval between palliative thoracic radiotherapy and bevacizumab
treatment strongly influences the frequency of adverse events (AEs) when
both are concurrently applied to patients with advanced lung cancer. Herein,
we aimed to elucidate the optimal time interval between the treatments in
these patients. Methods: The medical records of patients with stage IV nonsquamous non–small-cell lung
cancer (NSCLC) without epidermal growth factor receptor and anaplastic
lymphoma kinase alteration who underwent palliative thoracic radiotherapy
and bevacizumab treatment from January 2008 to January 2020 were collected
and analyzed. Patients were divided into 2 groups based on the time interval
between treatments: <3 weeks (⩽3W group) and >3 weeks (>3W group).
The progression-free survival (PFS) and overall survival (OS) for the time
intervals were evaluated using the Kaplan-Meier method and Cox proportional
hazard models. Adverse events were assessed by the fifth version of the
Common Terminology Criteria for Adverse Events. Results: In total, 72 patients with stage IV NSCLC (⩽3W group, 37 patients; >3W
group, 35 patients) who concurrently or sequentially received palliative
thoracic radiotherapy and bevacizumab treatment were included in this study.
In the >3W and ⩽3W groups, the median PFS (8 vs 6 months, respectively)
and OS (15 vs 12 months, respectively) differed significantly. Multivariate
analyses findings revealed significantly shorter OS in the latter group. In
addition, the frequency of most AEs was marginally higher in the latter
group (P > .05). Conclusions: The time interval between palliative thoracic radiotherapy and bevacizumab
treatment that offers optimal safety is >3 weeks.
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Affiliation(s)
- Weigang Xiu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Xiaotong Guo
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Min Yu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Yanying Li
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Yong Xu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Jiang Zhu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Jingjing Luo
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, P.R. China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, P.R. China
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2
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Superior Vena Cava Syndrome and Breast Cancer: A Case Series Highlighting a Rare Complication. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2022. [DOI: 10.1016/j.cpccr.2022.100161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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3
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Samper Ots PM, Vallejo Ocaña C, Martin Martin M, Celada Álvarez FJ, Farga Albiol D, Almendros Blanco P, Hernandez Machancoses A, Rico Oses M, Flamarique Andueza S, Romero Ruperto F, Maria Bueno C, Amaya Escobar E, Guerrero Gómez LL, Couñago F, Del Pino Alcántara M, Ruiz Villar MJ, Monroy Antón JL, Saez Bueno P, Luna Tirado J, Del Mar Puertas M, Bobo A, Diaz de Cerio Martínez I, Gascon Costoso N, Ferrer Albiach C. Stereotactic body radiotherapy for early-stage non-small cell lung cancer: a multicentre study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society). Clin Transl Oncol 2021; 24:342-349. [PMID: 34487307 DOI: 10.1007/s12094-021-02697-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic body radiotherapy (SBRT) has become the standard of care for patients with medically inoperable early-stage non-small cell lung cancer (NSCLC) and for patients who refuse surgery. The aim of this study was to evaluate the effectiveness and safety of primary SBRT in patients with early-stage NSCLC. MATERIALS/METHODS Retrospective multicenter study of 397 patients (416 primary lung tumours) treated with SBRT at 18 centres in Spain. 83.2% were men. The median age was 74.4 years. In 94.4% of cases, the tumour was inoperable. The pathological report was available in 54.6% of cases. SPSS vs 22.0. was used to perform all statistical analyses. RESULTS Complete response was obtained in 53.6% of cases. Significant prognostic factors were standard CT planning (p = 0.014) and 4D cone beam CT (p = 0.000). Acute and chronic toxicity ≥ grade 3 was observed in 1.2% of cases. At a median follow-up of 30 months, local relapse was 9.6%, lymph node relapse 12.8%, distant metastasis 16.6%, and another lung tumour 11.5%. Complete response was the only significant prognostic factor for local relapse (p = 0.012) and distant metastasis (p = 0.001). The local relapse-free survival was 88.7%. The overall survival was 75.7%. The cancer-specific survival was 92.7%. The disease-free survival was 78.7%. CONCLUSION SBRT is an effective and well-tolerated treatment option for patients with early-stage lung cancer who are not suitable for surgery. The most important prognostic factor for local and distant recurrence was complete response, which in our sample depended on the type of CT planning and the IGRT technique.
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Affiliation(s)
| | | | | | | | - D Farga Albiol
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - M Rico Oses
- Complejo Hospitalario de Navarra, Navarra, Spain
| | | | | | | | | | | | - F Couñago
- Hospital Universitario Quironsalud y Hospital La Luz Quironsalud, Madrid, Spain
| | | | | | | | - P Saez Bueno
- Hospital Universitario Central de la Defensa "Gómez Ulla", Madrid, Spain
| | - J Luna Tirado
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - A Bobo
- Hospital Ruber Internacional, Madrid, Spain
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4
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Giordano G, Fanzone L, Meo D, Piana S, Lentini V, Borracino S, Potenza E, Magnano San Lio V. Stenting of the superior vena cava and right pulmonary artery in a woman with a mediastinal mass and acute respiratory distress syndrome (ARDS). Radiol Case Rep 2021; 16:2437-2441. [PMID: 34257776 PMCID: PMC8260759 DOI: 10.1016/j.radcr.2021.05.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 11/20/2022] Open
Abstract
We report the case of a woman with a mass in the anterior and middle mediastinum (a non-small-cell lung carcinoma), determining significant compression of both superior vena cava and right pulmonary artery. The patient developed acute respiratory distress syndrome , necessitating intubation and admission to the Intensive Care Unit . Radiotherapy sessions to reduce the mass effect were attempted, without significant clinical improvement. Due to the persistence of severe hypoxemia, stenting of the superior vena cava and the right pulmonary artery was performed, the latter resulting in a significant improvement of the arterial blood gas parameters, allowing extubation of the patient. In our opinion, stenting of the superior vena cava and the pulmonary artery (or its branches) is an effective and safe treatment; it should be considered in similar cases, especially if other - less invasive - treatments fail.
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Affiliation(s)
- Giuseppe Giordano
- Unit of Diagnostic and Interventional Radiology ARNAS "Garibaldi-Nesima", Catania, Catania, Italy
| | - Luigi Fanzone
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies - University Hospital "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Diego Meo
- Unit of Diagnostic and Interventional Radiology ARNAS "Garibaldi-Nesima", Catania, Catania, Italy
| | - Sebastiano Piana
- Unit of Diagnostic and Interventional Radiology ARNAS "Garibaldi-Nesima", Catania, Catania, Italy
| | - Viviana Lentini
- Unit of Diagnostic and Interventional Radiology ARNAS "Garibaldi-Nesima", Catania, Catania, Italy
| | - Savino Borracino
- Intensive Care Unit, ARNAS "Garibaldi-Nesima", Catania, Catania, Italy
| | - Enrico Potenza
- Thoracic surgery, ARNAS "Garibaldi-Nesima", Catania, Catania, Italy
| | - Vincenzo Magnano San Lio
- Unit of Diagnostic and Interventional Radiology ARNAS "Garibaldi-Nesima", Catania, Catania, Italy
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5
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Zhou Y, Yu F, Zhao Y, Zeng Y, Yang X, Chu L, Chu X, Li Y, Zou L, Guo T, Zhu Z, Ni J. A narrative review of evolving roles of radiotherapy in advanced non-small cell lung cancer: from palliative care to active player. Transl Lung Cancer Res 2021; 9:2479-2493. [PMID: 33489808 PMCID: PMC7815368 DOI: 10.21037/tlcr-20-1145] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiotherapy, along with other loco-regional interventions, is conventionally utilized as a palliative approach to alleviate symptoms and mitigate oncological emergencies in advanced non-small cell lung cancer (NSCLC). Thanks to the ongoing improvement of medical treatments in the last decade, such as targeted therapy and immunotherapy, the survival of patients with advanced NSCLC has been considerably prolonged, making it feasible and clinically beneficial for radiotherapy to play a more active role in highly selected subpopulations. In this review, we will focus on the evolving roles of radiotherapy in advanced NSCLC. First of all, among patients who are initially unable to tolerate aggressive treatment due to severe symptoms caused by metastases and/or tumor emergencies, timely radiotherapy could significantly improve their performance status (PS) and general condition, thus giving them a chance for intensive treatment and prolonged survival. The efficacy, potential candidates, and optimal dose-fractionation regimens of radiotherapy in this clinical scenario will be discussed. Additionally, radiotherapy can play a curative role as a concurrent therapy, consolidation therapy, and salvage therapy for patients with oligo-metastatic, oligo-residual, and oligo-progressive disease, respectively. Accumulating evidence from recent clinical trials, basic research, and translational investigations regarding the potentially curative roles of radiotherapy in NSCLC patients with oligo-metastatic disease will be summarized. Moreover, with the advent of various small molecular tyrosine kinase inhibitors (TKIs), the treatment efficacy and overall survival of oncogene-addicted NSCLC with brain metastases have been significantly improved, and the clinical value and optimal timing of cranial radiotherapy have become topics of much debate. Finally, synergistic antitumor interactions between radiotherapy and immunotherapy have been repeatedly demonstrated. Thus, the immune sensitizing role of radiotherapy in advanced NSCLC is also highlighted in this review.
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Affiliation(s)
- Yue Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fan Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya Zeng
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Li Chu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiao Chu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yida Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liqing Zou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tiantian Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China
| | - Jianjiao Ni
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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6
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Wei S, Liu J, Li X, Song Z, Dong M, Zhao H, Zhao Q, Chen G, Chen J. A retrospective stenting study on superior vena cava syndrome caused by lung cancer. Thorac Cancer 2020; 11:1835-1839. [PMID: 32438532 PMCID: PMC7327698 DOI: 10.1111/1759-7714.13461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 11/29/2022] Open
Abstract
Background Superior vena cava syndrome (SVCS) is a common condition predominantly caused by lung cancer. The presence of symptoms of SVCS, such as elevated intracranial pressure and laryngeal edema, indicates an unfavorable prognosis for lung cancer patients. Superior vena cava (SVC) stenting is the first‐line treatment for SVCS. In this study, we retrospectively analyzed SVCS cases treated with stenting in our center to explore the safety and effectiveness of stenting in the treatment of SVCS. Methods We reviewed 16 patients with SVCS caused by lung cancer who were treated at our center with endovascular stenting between 2016 and 2018. Patient information such as age, sex, type of lung cancer, obstruction condition, complications, survival time, and postoperative treatments are summarized. Results There were no treatment‐related complications in the perioperative period in any of the patients. Examination at postoperative day 2 indicated that the accompanying SVCS symptoms had improved in all patients. The median survival of patients treated along with combined postoperative chemotherapy and antivascular targeted therapy reached seven months (1–18 months). Conclusions SVC stenting is effective as a first‐line treatment modality for patients with SVCS caused by lung cancer. In combination with other treatment modalities, it can significantly alleviate symptoms and reduce complications, and thus it plays an important role in the treatment of patients with SVCS caused by lung cancer.
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Affiliation(s)
- Sen Wei
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinghao Liu
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Li
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zuoqing Song
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Dong
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Honglin Zhao
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Qingchun Zhao
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Gang Chen
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
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7
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Abstract
Superior vena cava syndrome occurs from obstruction of the superior vena cava. The most common cause is malignancy. Small cell lung cancer and non-Hodgkin lymphoma are the most frequent culprits. Intravascular devices associated with thrombus are becoming more common causes. Classic symptoms include edema, plethora, and distended veins of the face, neck, and chest; shortness of breath; cough; headache; and hoarseness. Treatment in the emergency department is mostly supportive, with head elevation, oxygen, and steroids. Rarely, emergent airway issues and cerebral edema must be addressed. Definitive treatment includes radiotherapy, chemotherapy, and stenting.
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Affiliation(s)
- Shelly Zimmerman
- Emergency Medicine Residency, Norman Regional Health Systems, GME Office, 901 North Porter, Norman, OK 73071, USA; Department of Family Medicine, Oklahoma State University College of Osteopathic Medicine, 1111 West 17th Street, # A247, Tulsa, OK 74107, USA.
| | - Matthew Davis
- Emergency Medicine Residency, Norman Regional Health Systems, GME Office, 901 North Porter, Norman, OK 73071, USA
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8
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Brzezniak C, Oronsky B, Carter CA, Thilagar B, Caroen S, Zeman K. Superior Vena Cava Syndrome in a Patient with Small-Cell Lung Cancer: A Case Report. Case Rep Oncol 2017; 10:252-257. [PMID: 28611639 PMCID: PMC5465747 DOI: 10.1159/000464278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 11/19/2022] Open
Abstract
Superior vena cava (SVC) syndrome, a potential oncologic emergency, is closely associated with malignancy and right-sided lung cancer in particular. A case of SVC syndrome presenting with facial swelling, neck distension, and enlarged veins of the upper chest, which developed over a period of 5 weeks in a 46-year-old patient on a clinical trial with small-cell lung cancer, is reported. Computed tomography scan of the chest revealed slight enlargement of a superior conglomerate mediastinal lymphadenopathy and intramural thrombus of the SVC. The etiology, diagnosis, and treatment of the SVC syndrome are discussed.
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Affiliation(s)
| | | | - Corey A Carter
- aWalter Reed Military Medical Center Bethesda, Bethesda, Maryland, USA
| | | | | | - Karen Zeman
- aWalter Reed Military Medical Center Bethesda, Bethesda, Maryland, USA
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9
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Predictors of response to corticosteroids for dyspnea in advanced cancer patients: a preliminary multicenter prospective observational study. Support Care Cancer 2016; 25:1169-1181. [DOI: 10.1007/s00520-016-3507-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/21/2016] [Indexed: 12/19/2022]
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10
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Straka C, Ying J, Kong FM, Willey CD, Kaminski J, Kim DWN. Review of evolving etiologies, implications and treatment strategies for the superior vena cava syndrome. SPRINGERPLUS 2016; 5:229. [PMID: 27026923 PMCID: PMC4771672 DOI: 10.1186/s40064-016-1900-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/17/2016] [Indexed: 12/25/2022]
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.
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Affiliation(s)
- Christopher Straka
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5801 Forest Park Rd, Dallas, TX 75390 USA
| | - James Ying
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5801 Forest Park Rd, Dallas, TX 75390 USA
| | - Feng-Ming Kong
- Department of Radiation Oncology, GRU Cancer Center and Medical College of Georgia, Augusta, GA USA
| | - Christopher D Willey
- Department of Radiation Oncology, The University of Alabama Birmingham, Birmingham, AL USA
| | - Joseph Kaminski
- Dattoli Cancer Center, 2803 Fruitville Rd, Sarasota, FL 34237 USA
| | - D W Nathan Kim
- Department of Radiation Oncology, Texas Oncology, 1700 W. Highway 6, Waco, TX 76712 USA
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11
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Gong ZH, Yan LJ, Sun JG. Postoperative radiotherapy to stabilize a tumor embolus in clear cell renal cell carcinoma: A case report. Oncol Lett 2014; 8:1856-1858. [PMID: 25202425 PMCID: PMC4156207 DOI: 10.3892/ol.2014.2421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 06/24/2014] [Indexed: 11/18/2022] Open
Abstract
Superior vena cava (SVC) syndrome results from clear cell renal cell carcinoma and is a challenge in clinical practice due to its pathological complexity and a lack of research data. The current study presents a 49-year-old female with symptoms of exertional dyspnea and increased fatigue, which had persisted for 15 months, as well as bilateral edema in the lower limbs for two days. A transesophageal echocardiogram demonstrated a right atrial mass originating from the inferior vena cava (IVC; size, 14×8 cm) that caused a tricuspid inflow obstruction. Following a partial resection of the thrombus, a clear cell renal cell carcinoma was identified by histological examination. The patient received intensity-modulated radiation therapy following refusal of other therapeutic methods. The eleven-month follow-up indicated that the tumor on the kidney and IVC was stable. Intensity-modulated radiation therapy may be beneficial to patients with clear cell renal cell carcinoma and SVC syndrome. However, additional studies are required to obtain further data regarding the treatment of this syndrome.
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Affiliation(s)
- Zhi-Hua Gong
- Department of Oncology, Cancer Institute of People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P.R. China
| | - Lv-Jun Yan
- Department of Oncology, Cancer Institute of People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P.R. China
| | - Jian-Guo Sun
- Department of Oncology, Cancer Institute of People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P.R. China
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12
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Superior vena cava syndrome caused by a malignant tumor: a retrospective single-center analysis of 124 cases. J Cancer Res Clin Oncol 2014; 140:2129-34. [DOI: 10.1007/s00432-014-1764-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/26/2014] [Indexed: 10/25/2022]
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13
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Joshi JM, Desai UD. Unilateral superior vena cava syndrome. J Postgrad Med 2014; 60:390-3. [DOI: 10.4103/0022-3859.143966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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15
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Chaudhary K, Gupta A, Wadhawan S, Jain D, Bhadoria P. Anesthetic management of superior vena cava syndrome due to anterior mediastinal mass. J Anaesthesiol Clin Pharmacol 2012; 28:242-6. [PMID: 22557753 PMCID: PMC3339735 DOI: 10.4103/0970-9185.94910] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Anesthetic management of superior vena cava syndrome carries a possible risk of life-threatening complications such as cardiovascular collapse and complete airway obstruction during anesthesia. Superior vena cava syndrome results from the enlargement of a mediastinal mass and consequent compression of mediastinal structures resulting in impaired blood flow from superior vena cava to the right atrium and venous congestion of face and upper extremity. We report the successful anesthetic management of a 42-year-old man with superior vena cava syndrome posted for cervical lymph node biopsy.
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Affiliation(s)
- Kapil Chaudhary
- Department of Anesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
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16
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Lin RJ, Adelman RD, Mehta SS. Dyspnea in palliative care: expanding the role of corticosteroids. J Palliat Med 2012; 15:834-7. [PMID: 22385025 DOI: 10.1089/jpm.2011.0260] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Dyspnea is one of the most common symptoms in advanced cancer patients at the end of their life. It is often multifactorial with diverse malignant, nonmalignant, and cancer treatment related etiologies. Oxygen, opiates, and anxiolytics are commonly administered. Here a complex case of progressive dyspnea and its treatments in a patient with advanced pancreatic cancer is described, and its multiple potential contributing causes are identified and clinical responses evaluated. Literature review is conducted on pulmonary drug toxicity and tumor lymphangitic spread, and the role of corticosteroids in relieving dyspnea in the palliative care setting.
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Affiliation(s)
- Richard J Lin
- Department of Medicine, Division of Hospital Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA.
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17
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Hague J, Tippett R. Endovascular Techniques in Palliative Care. Clin Oncol (R Coll Radiol) 2010; 22:771-80. [DOI: 10.1016/j.clon.2010.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 07/29/2010] [Accepted: 08/04/2010] [Indexed: 10/19/2022]
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19
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20
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Abstract
With about 20% of all lung cancers small cell lung cancer (SCLC) represents a major subset of this entity. Although therapeutic improvements did not receive as much attention as in non small cell lung cancer (NSCLC), many small steps of clinical progress have been achieved within the last 20 years. An optimal treatment should be based on an interdisciplinary treatment plan. The standard treatment in localized stages represents combined radiation and chemotherapy. Cisplatin and etoposide are in this concern considered as a gold standard. 3D-planned conformal radiotherapy should start as early as possible and should be applied concomitantly to chemotherapy and in certain cases even in a hyperfractionated treatment protocol. In very early stages surgical resection could be an option in selected cases. In advanced stages a platinum-based doublet offers high response rates. As already established in limited disease prophylactic cranial irradiation is now also indicated in extensive disease in case of any tumor remission. In the second line treatment and in patients with reduced performance status topotecan is recommended. Similar as in NSCLC pemetrexed might become an alternative treatment option in the second line setting. In the field of new targeted therapies bevacizumab achieved the most promising results. The present review highlights historical milestones and up-to-date trends in radiotherapy, chemotherapy and surgery. Furthermore, the role of experimental strategies and the management of certain special clinical situations are discussed.
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Hematological and Oncological Emergencies. CONCISE MANUAL OF HEMATOLOGY AND ONCOLOGY 2008. [PMCID: PMC7120105 DOI: 10.1007/978-3-540-73277-8_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Fong KM, Yang IA, Zimmerman PV, Bowman RV. Cochrane systematic reviews of treatments for lung cancer. Respir Med 2006; 99:1071-8. [PMID: 15955688 DOI: 10.1016/j.rmed.2005.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Accepted: 04/26/2005] [Indexed: 10/25/2022]
Abstract
Morbidity and mortality from lung cancer is a major burden to global health. The integration of expert clinical experience, patient preference and high-quality evidence, including Cochrane systematic reviews, can only help improve outcomes from this highly lethal condition.
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Affiliation(s)
- K M Fong
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia.
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23
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Kim YI, Kim KS, Ko YC, Park CM, Lim SC, Kim YC, Park KO, Yoon W, Kim YH, Kim JK, Ahn SJ. Endovascular stenting as a first choice for the palliation of superior vena cava syndrome. J Korean Med Sci 2004; 19:519-22. [PMID: 15308841 PMCID: PMC2816884 DOI: 10.3346/jkms.2004.19.4.519] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To assess the effectiveness of endovascular stenting for the palliation of superior vena cava (SVC) syndrome, endovascular stent insertion was attempted in 10 patients with symptomatic occlusion of the SVC. All the patients had known malignant disease of the thorax. Eight patients had been treated previously with chemotherapy and radiotherapy (n=5), chemotherapy alone (n=2), or pneumonectomy and radiotherapy (n=1). After developing SVC syndrome, all the patients were stented before receiving any other treatment. After single or multiple endovascular stents were inserted, five of eight patients were treated with chemotherapy and radiotherapy (n=2) or chemotherapy alone (n=3). Resolution of symptoms was achieved in nine patients within 72 hr (90%). In one patient, the symptoms did not disappear until a second intervention. At follow up, symptoms had recurred in two of ten patients (20%) after intervals of 15 and 60 days. Five patients have died from their cancers, although they remained free of symptoms of SVC occlusion until death. In conclusion, endovascular stent insertion is an effective treatment for palliation of SVC syndrome. Endovascular stent insertion can be considered the first choice of treatment, due to the immediate relief of symptoms and excellent sustained symptomatic relief.
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Affiliation(s)
- Yu-Il Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyu-Sik Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Chun Ko
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chang-Min Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Chul Lim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Chul Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung-Ok Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Woong Yoon
- Department of Diagnostic Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Yoon-Hyun Kim
- Department of Diagnostic Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Jae-Kyu Kim
- Department of Diagnostic Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Ja Ahn
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea
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