Superior vena cava obstruction: is stenting necessary?

No therapy is currently available for patients with recurrent vascular obstruction of the superior vena cava (SVC) caused by tumor regrowth after chemotherapy or radiation therapy. Intravascular stenting is a new option for the treatment of vena cava syndrome. Forty cancer patients with SVC syndrome (SVCS) were evaluated by computed tomography (CT) and venography. The SVC or its tributaries were stenosed or thrombosed in all patients. The etiology was malignant in all but 2 cases: non-small-cell lung carcinoma (n = 28), mediastinal nodal metastasis (n = 5), lymphoma (n = 2), pleural mesothelioma (n = 2), small-cell lung carcinoma (n = 1), and postradiation fibrous mediastinitis (n = 2). Stenting was achieved in 39 of the 40 patients, and clinical symptoms subsided in 92%. Stents remained patent in 36 of these 39 patients throughout a mean follow-up of 24 weeks (range 3 days to 24 months). SVC stenting is safe, effective and allows rapid cure of SVCS and port catheter implantation in patients in poor health.

[Percutaneous endoscopic gastrostomy: cost/benefit analysis in patients with carcinoma of the upper aero-digestive tract]

The aim of this retrospective study was to evaluate the cost and benefit of percutaneous fluoroscopic gastrostomy feeding (PFG) in 70 cancer patients with advanced stage disease of the upper-aero digestive tract; we retrospectively analyzed the consequences in terms of nutritional status (evaluated by weight and body mass index), the possibility to lead a treatment by high dose chemo-radiotherapy to the end of the therapeutic schedule, the feasibility, complications and cost ratios. Three weeks after the procedure, no major complication was observed, the initial nutritional threshold was conserved. PFG is a safe and effective technique; the additional cost is low (2%) compared with the total cost of hospitalization.