No abstract

Background: Superior vena cava syndrome management has been traditionally radiation therapy, chemotherapy or chemoradiation, depending on the underlying malignancy involved and individual clinicopathological features of the case. Recent emergence of endovascular stents offer the opportunity for immediate relief of the venous stenosis. This review examines findings from the published series which used endovascular prosthesis for this syndrome with regards to efficacy and safety. Methods: Literature search identified studies using endovascular stents as initial therapy or for recurrence of malignant superior vena cava syndrome. Effectiveness and toxicity from stent placement was assessed. Results: Endovascular stent placement provides immediate haemodynamic relief of venous compression either before or after definitive therapy in the majority of cancer patients. Severe bleedings, cardiopulmonary complications and stent migrations remain significant problems for patient management. Conclusions: Endovascular prosthesis is an effective modality for malignant superior vena cava syndrome with acceptable morbidity. Prospective studies should be performed to determine the optimal anticoagulation regimen.

Kaposi's sarcoma is a malignancy for which there is no satisfactory standardized, nor even a very good, method of treatment. When the condition is indolent and but slowly progressive on the feet, where it is most common, conservative measures of good local hygiene and palliation of edema, if present, by mechanical support of circulation by elastic garments is generally advised. Small, dispersed nodules on the feet or hands, if symptomatic or subject to trauma, are amenable to extirpation by minor surgical procedures. When, however, the disease becomes continuous, symptomatic, extensive, or rapidly progressive and threatens to become disabling, radiotherapy is a first and best treatment. Helpful as radiotherapy may be in such cases, it is not and cannot be expected to be curative because it is practiced only on limited areas of clinically evident process and in that way does not influence the unpredictable rate of progression nor prevents development of multicentric foci of the disease in its capricious course. It is suggested that widespread radiotherapy in conservative doses be accorded early and prophylactically in cases of Kaposi's sarcoma immediately upon diagnosis and surely upon threat of rapid progression. There is precedent for such treatment in the extensive radiation practiced in Hodgkin's disease. Such treatment may prevent or at least halt progression of Kaposi's sarcoma by affecting clinically undetectable, active foci and foci in potential of malignant transformation. It can be designed to do no harm.

No abstract