Superior vena

cava obstruction

Case 1

Clinical presentation

Wilson et al. Superior Vena

4
Cava Syndrome with Malignant
Causes. N Engl J Med

Differential diagnosis

Wilson et al. Superior Vena Cava Syndrome 7

with
Malignant Causes. N Engl J Med 2007;356:1862-9.

Pathophysiology

Wilson et al. Superior Vena Cava Syndrome with

Malignant Causes. N Engl J Med 2007;356:1862-9.

10

Findings on imaging

11

12
Wilson et al. Superior Vena Cava Syndrome with Malignant Causes. N Engl J Med

13

14

15

Definitive diagnosis

16

Complications of definitive
diagnosis

17

Dosios et al. Chest 2005; 128:1551

1556

18

Management
Is it an emergency?
Supportive care
Definitive treamtent
Chemotherapy
Radiotherapy
Stent
Surgery
19

Is it an emergency?

20

Supportive care

Elevate patients head

Steroids?
Loop diuretics?
Evidence???

Special cases:
IV placement
Thrombosis
21

Definitive therapy
Chemotherapy
NHL
SCLC
Germ cell tumours

Radiotherapy

22

23

Surgery

24

Evidence
Clinical Oncology (2002)
SCLC: relief?
NSCLC: relief?
Stent: relief?
Rapidity of response?
Relapse rates?

25

Rowell et al. Steroids, radiotherapy, chemotherapy and stents for superior

26
vena caval obstruction in carcinoma of the bronchus: a systematic review.
Clinical Oncology 2002; 14:338-351.

Rowell et al. Steroids, radiotherapy, chemotherapy and stents for superior

27
vena caval obstruction in carcinoma of the bronchus: a systematic review.
Clinical Oncology 2002; 14:338-351.

Rowell et al. Steroids, radiotherapy, chemotherapy and stents for superior

28
vena caval obstruction in carcinoma of the bronchus: a systematic review.
Clinical Oncology 2002; 14:338-351.

Outcome

Chemotherap
y

Relief of
symptoms
(SCLC)

76.9%

70.4% (prior CT)

94.4% (no CT)

Relief of
symptoms
(NSCLC)

59%

63%

Rapidity of
response
Relapse rates

Radiotherapy

Stent
95% (all)

7-21 days

24-72 hrs

16.7% (SCLC)

11% (all)

Caveats:
18.5% (NSCLC)
Trials included in systematic review were of
moderate quality (44 non-randomized, 2 RCTs)
Small numbers of patients

Rowell et al. Steroids, radiotherapy, chemotherapy and stents for superior

29
vena caval obstruction in carcinoma of the bronchus: a systematic review.
Clinical Oncology 2002; 14:338-351.

Prognosis
SVCO itself
Malignancy-related
Is SVCO an independent prognostic
factor for survival?

30

Case 2

31

SVCO

In distress
Stridor, laryngeal
edema, cerebral
edema

Symptomatic

Urgent steroids,
stent, radiotherapy

No distress

Stent
Proceed to "No
distress"

Obtain pathologic
diagnosis

Tailored treatment
depending on
diagnosis

Lymphoma

Chemotherapy,
radiotherapy,
steroids

SCLC

Chemotherapy,
radiotherapy

NSCLC

Radiotherapy,
chemotherapy

Thymoma

Chemotherapy,
surgery, then
radiotherapy32

33