Management of superior vena cava syndrome in critically ill cancer patients

Morin, Sarah; Grateau, Adeline; Reuter, Danielle; Kerviler, É. de; Margerie-Mellon, Constance de; Bazelaire, Cédric de; Zafrani, Lara; Schlemmer, Benoı̂t; Azoulay, Élie; Canet, Emmanuel

doi:10.1007/s00520-017-3860-z

Cited by 11 publications

(5 citation statements)

References 37 publications

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“…Critical care unit interventions like intubation was required in 30%, inotrope infusion in 14% and renal replacement therapy in 6%. Pleural and pericardial drainage was performed in 26%, and 8% patients, respectively (9). Another study from India analyzed 55 patients of T-LBL patients with mediastinal mass with a median age of 18years, 36/55 presented with SVCS.…”

Section: Discussionmentioning

confidence: 99%

Critical Care Needs and Outcome of Pediatric T cell Lymphoblastic Leukemia or Lymphoma with Superior Venacaval Syndrome

Yadav¹,

Upasana²,

Thakkar³

et al. 2022

Preprint

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Background- Superior Vena Cava Syndrome (SVCS) is a life-threatening oncological emergency affecting children with T-cell Acute lymphoblastic Leukemia (T-ALL)/ T-Lymphoblastic Lymphoma (T-LBL). This can prove fatal if not managed appropriately and promptly. Method- We describe critical care needs and outcome of T-ALL/T-LBL patients managed in our unit from 1 May 2016 to 31 March 2021. Result- Twenty-three of the 120 pediatric ALL/LBL patients (19%) managed in our unit had T-ALL/T-LBL. Eleven (48%) patients presented with SVCS. All presented with cough and dyspnea. Chest X-Ray showed mediastinal widening in all patients. Flow cytometry in various body fluids could reach prompt diagnosis in 90% patients and mass biopsy was performed in only 1 patient. Eight patients required Pediatric Intensive Care Unit support. All 11 patients were started on corticosteroids soon after diagnosis of SVCS. The median time to symptom relief was 4 days and that for significant improvement on X-ray was 7days. At a median follow up of 23-months (6-63 months) overall survival and event-free survival was 75%. Conclusion- T-ALL/T-LBL patients with SVCS with good critical care can have improved outcomes. Prompt therapeutic interventions like pericardiocentesis can be life-saving. Flow cytometry can be a handy tool for quick diagnosis and help avoid invasive procedures in sick patients.

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Section: Discussionmentioning

confidence: 99%

Critical Care Needs and Outcome of Pediatric T cell Lymphoblastic Leukemia or Lymphoma with Superior Venacaval Syndrome

Yadav¹,

Upasana²,

Thakkar³

et al. 2022

Preprint

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“…Despite the wide variability depending on the underlying malignancy and the improvements of treatment, the median survival among patients who present malignant SVC syndrome remains approximately six months ( 83 ). In patients with advanced tumors and poor prognosis, palliative care should be initiated early ( 84 ).…”

Section: Discussionmentioning

confidence: 99%

Principles of medical and oncological management of giant masses of the mediastinum: a narrative review

Conci¹,

Grilli²,

Dall’Olio³

2022

Mediastinum

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Background and Objective Giant mediastinal tumors are represented by well-defined histological variants originating from different structures and compartments while their clinical presentation may be similar and characterized by the same set of symptoms, the well-known mediastinal syndrome (MS). In 80% of cases the MS is caused by malignant neoplasms, such as lung tumors, in 10–18% of cases by hematological neoplasms and in 2–3% by benign causes. In this review we investigated the medical treatment of main giant mediastinal tumors, focusing our interest on the objective response rate (ORR), as it represents the most suitable parameter to predict the volumetric reduction of the neoplasm and, consequently, the regression of their most severe complication, the MS. We will also cover the supportive and symptomatic treatment of MS. Methods We performed a deep analysis of the recent international literature published on PUBMED, UpToDate and Medline. The literature search was undertaken from origin until November 30th, 2021, and we only considered publications in English. Key Content and Findings Considering the variety of pathologies that can occur in the mediastinum, a rapid histological characterization of the neoplasm is mandatory. In fact, the treatment of these neoplasms includes different approaches, sometimes used in combination, which include chemotherapy, radiotherapy, and surgery. The vena cava syndrome (VCS), due to its high mortality, is considered an oncological emergency and, therefore, requires effective treatments carried out urgently, evaluated in multidisciplinary meeting. Conclusions The treatment of MS includes both antiblastic treatments and therapies directed to the symptoms. Among the former, chemotherapy, target therapy, radiation and surgery may be used, according to the etiology of MS. Among the latters, supportive therapies, interventional radiology procedures such as stenting may help manage this syndrome, despite the prognosis is poor in most cases and linked to the histology of the tumor, which therefore represents the most important prognostic factor.

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“…2 O surgimento de sintomas como obstrução da via aérea e edema da laringe são considerados ameaçadores de vida, com necessidade de intervenção por parte dos cuidados intensivos e obrigam a uma intervenção terapêutica emergente. 1,6 Na série de casos apresentada, verificou-se a presença dos sinais e sintomas citados, sendo que, apenas um dos doentes apresentou sinais de circulação colateral. Em nenhum dos casos se verificou a presença de edema da laringe e/ou obstrução da via aérea, mantendo-se os doentes hemodinamicamente estáveis e sem necessida-de de intervenção por parte da Medicina Intensiva.…”

Section: Discussão E Conclusãounclassified

“…3 O tratamento da síndrome da veia cava superior é um desafio, uma vez que não existem guidelines definidas, sendo que, a maioria das estratégias adotadas apresenta benefício incerto e a sua utilização tem como base a opinião de peritos. 6 A terapêutica desta síndrome pode dividir-se em sintomática/suporte e definitiva/dirigida. 3 As medidas conservadoras ou terapêutica de suporte/ sintomática são geralmente a terapia de primeira linha com o intuito de diminuir os sintomas de congestão venosa e a progressão da trombose.…”

Section: Discussão E Conclusãounclassified

Síndrome da Veia Cava Superior: Um desafio para o Internista de um Hospital Distrital

Gaudêncio

Faria

Batista

et al. 2021

Gaz Med

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A síndrome da veia cava superior surge quando existe uma diminuição ou obstrução do fluxo venoso da cabeça, pescoço e membros superiores através da veia cava superior por trombose ou compressão extrínseca da mesma. Pode ter diversas etiologias, sendo a causa neoplásica uma das mais frequentes, constituindo uma urgência oncológica. Numa abordagem inicial, o uso de corticoterapia e diuréticos endovenosos, combinado com a elevação da cabeceira são medidas fundamentais. Para além disso, o tratamento da doença de base, radioterapia de urgência e radiologia de intervenção são as opções mais viáveis. Os autores propõem-se apresentar uma série de casos que surgiram no serviço de urgência de um hospital distrital durante o período de um ano. Dois casos surgiram em doentes com neoplasias já conhecidas e em tratamento, sendo as neoplasias em questão - linfoma MALT brônquico e carcinoma papilar da tiroide com metastização pulmonar e mediastínica. Outro dos doentes tinha uma formação nodular a nível do lobo superior direito do pulmão, sem identificação histológica. No outro caso, esta síndrome foi a apresentação inicial, tendo os exames complementares demonstrado a presença de massa mediastínica, biopsada através de mediastinoscopia, que revelou linfoma difuso de grandes células B. Os doentes apresentavam idades compreendidas entre os 61 e 81 anos. Para todos, foi pedido apoio ao hospital de referência pela inexistência de radiologia de intervenção e radioterapia no nosso hospital. A síndrome da veia cava superior pode apresentar várias etiologias, tendo os casos descritos ocorrido em contexto de doença oncológica. Esta série de casos alerta-nos para o desafio clínico e sobretudo terapêutico num hospital distrital, assim como, reforça a importância de equipa multidisciplinar e inter-hospitalar para a melhor orientação dos doentes, procurando oferecer as melhores alternativas terapêuticas.

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Management of superior vena cava syndrome in critically ill cancer patients

Abstract: Airway obstruction and pleural and pericardial effusions contributed to the unstable condition of cancer patients with SVCS. The vital prognosis of SVCS was mainly related to the underlying diagnosis.

Cited by 11 publications

References 37 publications

Critical Care Needs and Outcome of Pediatric T cell Lymphoblastic Leukemia or Lymphoma with Superior Venacaval Syndrome

Critical Care Needs and Outcome of Pediatric T cell Lymphoblastic Leukemia or Lymphoma with Superior Venacaval Syndrome

Principles of medical and oncological management of giant masses of the mediastinum: a narrative review

Síndrome da Veia Cava Superior: Um desafio para o Internista de um Hospital Distrital

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