Vascular stenting for palliation of superior vena cava obstruction in non-small-cell lung cancer patients: a future 'standard' procedure?
BACKGROUND
Stenting is a relatively new option in the management of superior vena cava obstruction (SVCO), but available data often concern non-malignant and/or various malignant diseases.


OBJECTIVE
The aim of this study was to assess the efficacy of vascular stenting as a first-choice treatment in SVCO in the exclusive setting of NSCLC.


METHODS
Retrospective study of NSCLC patients with SVCO treated in the past year. Demographic data, disease characteristics, etiologic and palliative treatment (use of vascular stenting) were recorded as well as treatment outcome and survival.


RESULTS
17 patients were recruited. Eight had vascular stenting while 9 did not. Except for stenting, there was no difference between the two groups (median age 54 years; 80% men; 53% stage IIIB and 47% stage IV). Stenting (median length 60 mm) achieved complete resolution of SVCO more frequently (75 vs. 25%, p = 0.05) and faster (2 vs. 21 days, p = 0.002) without immediate or delayed complication. All patients with stents received anticoagulation therapy. Relapse rate after complete response (33 g, 50%, p = 0.6) was lower and time to relapse (6.5 g, 2 months) was longer for patients undergoing stenting, without reaching statistical significance. Median overall survival was not statistically different (8 and 5 months, p = 0.06).


CONCLUSIONS
This study demonstrated the effectiveness of vascular stenting for SVCO in NSCLC patients. The high response rate, quick effect and safety of vascular stenting make this palliative treatment a candidate as a potential standard procedure. The results, however, must be confirmed in a prospective randomized trial including quality of life assessment.
Greillier
Laurent
L
Department of Thoracic Oncology, Méditerranée University (Aix-Marseille II), Assistance Publique-Hôpitaux de Marseille, Marseille, France.
Barlési
Fabrice
F
Doddoli
Christophe
C
Durieux
Olivier
O
Torre
Jean-Philippe
JP
Gimenez
Céline
C
Kleisbauer
Jean-Pierre
JP
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000209:etiology* / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
D000925:Anticoagulants