A contemporary perspective on superior vena cava syndrome.
The superior vena cava (SVC) syndrome is usually associated with advanced malignancy and has a dismal prognosis. In order to analyze the impact of newer diagnostic and therapeutic modalities, we retrospectively examined the last 45 consecutive cases of SVC syndrome treated over a 12-year period. The underlying causes were advanced lung cancer (57%), mediastinal tumors (20%), and metastatic solid malignancy (5%). Forty-two patients (93%) were treated with external beam radiotherapy and/or chemotherapy with a mean patients survival of 3 months; 11 of 42 patients (26%) were treated without histologic diagnosis. Symptoms of SVC obstruction resolved in 80% of patients who underwent radiotherapy, with a mean interval of 4 weeks. The most common cause of death was respiratory arrest. Of the three patients with benign disease, two underwent caval reconstruction with greater than 3-year patency and relief of symptoms. We conclude that (1) SVC syndrome portends a grim prognosis when associated with malignancy but usually responds to radiation or chemotherapy; (2) CT scan is the best available method to document the extent and location of involvement; and (3) patients with benign disease should be evaluated for caval reconstruction, which may produce rewarding long-term results.
Chen
J C
JC
Department of Surgery, Harbor-UCLA Medical Center, UCLA School of Medicine, Torrance 90509.
Bongard
F
F
Klein
S R
SR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D003663:Decision Trees; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013479:Superior Vena Cava Syndrome / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery