Treatment of malignant superior vena caval obstruction.A randomized study

Abstract

A clinical trial of 2 methods of treating malignant superior vena caval obstruction is presented. Twenty‐eight selected patients were allocated to treatment with radiation and nitrogen mustard or radiation alone according to a strictly administered randomization scheme. It appears that there is no apparent advantage to the use of nitrogen mustard prior to irradiation. It would appear that, in view of the side effects of nitrogen mustard, the use of the initially high daily dose radiation technique, combined with judicious use of diuretics, would be preferable.

Management of Mediastinal Compression due to Bronchogenic Carcinoma

“…Of these 97 per cent, bronchogenic carcinoma accounts for nearly 75 per cent, lymphoma for 15 per cent, and metastatic carcinoma for 7 per cent (6,7,8). In our material about 20 per cent of the patients with bronchogenic carcinoma presented with mediastinal compression, which is comparable to other series (3, 8).…”

The Difficulties of a Randomized Study in Superior Vena Caval Obstruction

“…Nodal disease caused the SVCO in the majority of cases (11/18; 61%). Presenting symptoms were dyspnea (17), fatigue (12), swelling (13), cough (12), difficulty lying flat (9), chest pain (8), difficulty swallowing (3), hemoptysis (5), headache (4), and syncope (2). Seventeen patients described three or more symptoms, up to a maximum of eight.…”

“…In particular, there is a lack of randomized studies: an electronic literature search from 1966 to 2001 identified only three randomized trials, which looked at the use of chemotherapy and radiotherapy. 5,12,13 There were no randomized studies of the use of SVC stents, nor did any studies, either randomized or not, explore the effectiveness of steroids in this patient group. Ninety-eight nonrandomized studies were identified, but methodological issues were raised.…”

Endovascular Stenting as a First Choice for the Palliation of Superior Vena Cava Syndrome

“…General medical treatment (i.e., bed rest, elevation of the head, diuretics, steroids, and anticoagulation) is of limited clinical benefit (2). Radiation therapy is widely advocated for SVCS caused by radiosensitive tumors and provides relief by reducing tumor volume (10). Radiotherapy and chemotherapy are the standard forms of treatment, and a combination of the two has been used (11).…”