Endovascular stenting for end-stage lung cancer patients with superior vena cava syndrome post first-line treatments - A single-center experience and literature review

Tzu-Ting Kuo; Po-Lin Chen; Chun-Che Shih; I-Ming Chen

doi:10.1016/j.jcma.2017.04.005

Endovascular stenting for end-stage lung cancer patients with superior vena cava syndrome post first-line treatments - A single-center experience and literature review

J Chin Med Assoc. 2017 Aug;80(8):482-486. doi: 10.1016/j.jcma.2017.04.005. Epub 2017 May 10.

Authors

Tzu-Ting Kuo¹, Po-Lin Chen¹, Chun-Che Shih², I-Ming Chen³

Affiliations

¹ Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan, ROC.
² Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan, ROC.
³ Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan, ROC. Electronic address: imchen@vghtpe.gov.tw.

PMID: 28501315
DOI: 10.1016/j.jcma.2017.04.005

Abstract

Background: Superior vena cava (SVC) syndrome is a major complication that occurs when a growing lung malignancy compresses the SVC extrinsically. Current treatment options include radiotherapy or chemotherapy to shrink the tumor or endovascular stenting of the SVC to restore flow. Herein, we report a case series treated in a single institution to demonstrate the safety, effectiveness, and outcomes of salvage and primary stenting for malignant SVC obstruction.

Methods: A total of 12 male patients with malignant superior vena cava obstruction caused by lung cancer underwent SVC stenting from October 2009 to May 2015. Data were reviewed retrospectively, including demographic and clinical characteristics, procedural details, and outcomes.

Results: Seven patients had received radiotherapy prior to SVC stenting, while the other five patients received stenting as first-line therapy for SVC syndrome. Only one patient experienced initial symptomatic improvement after radiotherapy, and symptoms of SVC syndrome recurred one year later. Wallstents^® (Boston Scientific, Natick MA, USA) were used in all patients. Preoperatively, the mean narrowest SVC diameter measured by CT was 2.16 mm (0-5.5 mm). Technical success was achieved in all patients without complications such as pulmonary embolism, rupture or bleeding. Postoperative mean narrowest SVC diameter measured by CT during follow-up was 11.17 mm (8-13.5 mm). Symptoms of SVC syndrome such as arm and face swelling and dyspnea improved within 1-5 days in all patients. After median follow-up duration of 11.5 months, only one patient presented recurrent SVC syndrome due to in-stent thrombosis two months after stenting.

Conclusion: Salvage SVC stenting remains a safe and effective treatment for patients with SVC obstruction after failure of radiotherapy and chemotherapy. Primary stenting may be considered at initial presentation of SVC syndrome to improve patients' quality of life.

Keywords: Lung neoplasm; Stent; Superior vena cava syndrome.

Publication types

Review

MeSH terms

Adult
Aged
Female
Humans
Lung Neoplasms / complications*
Lung Neoplasms / therapy
Male
Middle Aged
Retrospective Studies
Stents*
Superior Vena Cava Syndrome / therapy*