Subject(s)
Azygos Vein/diagnostic imaging , Heart Atria/diagnostic imaging , Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Vena Cava, Superior/diagnostic imaging , Aged , Azygos Vein/pathology , Azygos Vein/radiation effects , Dose Fractionation, Radiation , Heart Atria/pathology , Humans , Male , Neoplasms/pathology , Neoplasms/radiotherapy , Predictive Value of Tests , Radiotherapy, Conformal , Vena Cava, Superior/pathology , Vena Cava, Superior/radiation effectsABSTRACT
Small cell lung cancer is a highly chemo-sensitive malignancy. As it often presents with a central lesion, superior vena cava obstruction (SVCO) is not an uncommon manifestation. From January 1990 to December 1993, 161 patients with small cell lung carcinoma were seen at our institution. Twenty (12.4%) of these patients presented with symptoms and signs of SVCO. Initial therapy consisted of radiotherapy in 4 patients and chemotherapy in 16 patients. Of those treated with chemotherapy, patient characteristics included 13 males, median age of 62.5 years (range 51 to 78 years), Eastern Co-operative Oncology Group (ECOG) performance status of 3 to 4 in 7 patients; 1 to 2 in 9 patients, and limited stage disease in 8 patients. The median period of follow-up was 5 months. Nine patients received a combination of cisplatin and etoposide (EP), 5 had cyclophosphamide, doxorubicin and vincristine, 1 had cyclophosphamide, etoposide and vincristine and 1 had monotherapy with oral etoposide. Overall response to chemotherapy was 81% (with 31% complete responses). All responders had resolution of SVCO. Only 3 patients did not respond (1 patient defaulted, 1 patient died of neutropenic sepsis at week one and 1 patient had stable disease). Resolution of SVCO was noted within the first 2 weeks after the first cycle; the earliest being 3 days. The only patient given single-agent oral etoposide responded within 10 days after initiation of treatment. Of the 7 patients with poor performance status (ECOG 3 to 4), 3 died from treatment-related complications. Chemotherapy is highly effective as a primary treatment of small cell lung carcinoma despite presentation with SVCO. However, caution is advised in the use of combination chemotherapy for those presenting with poor performance status. Initial therapy with oral etoposide or radiotherapy should be considered as possible alternatives for these patients.
Subject(s)
Carcinoma, Small Cell/drug therapy , Lung Neoplasms/drug therapy , Neoplastic Cells, Circulating/drug effects , Vena Cava, Superior/drug effects , Aged , Antibiotics, Antineoplastic/administration & dosage , Antineoplastic Agents/administration & dosage , Antineoplastic Agents, Alkylating/administration & dosage , Antineoplastic Agents, Phytogenic/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Small Cell/radiotherapy , Cisplatin/administration & dosage , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Etoposide/administration & dosage , Female , Follow-Up Studies , Humans , Lung Neoplasms/radiotherapy , Male , Middle Aged , Neoplasm Staging , Neoplastic Cells, Circulating/radiation effects , Remission Induction , Survival Rate , Time Factors , Vena Cava, Superior/radiation effects , Vincristine/administration & dosageABSTRACT
A 59-year-old man developed superior vena caval obstruction 20 years after receiving a radiation treatment for primary germinal cell tumor of the mediastinum. Venous decompression was achieved by anastomosing a 10-mm ringed polytetrafluoroethylene graft from the left internal jugular vein to the right atrium, which yielded immediate relief of symptoms. A left internal jugular venogram demonstrated graft patency 11 months post-operatively, and the patient remained free of symptoms of superior vena caval obstruction 29 months postoperatively.
Subject(s)
Mediastinal Neoplasms/radiotherapy , Neoplasms, Germ Cell and Embryonal/radiotherapy , Radiation Injuries/etiology , Superior Vena Cava Syndrome/etiology , Vena Cava, Superior/radiation effects , Cobalt Radioisotopes/adverse effects , Cobalt Radioisotopes/therapeutic use , Combined Modality Therapy , Humans , Male , Mediastinal Neoplasms/surgery , Middle Aged , Neoplasms, Germ Cell and Embryonal/surgery , Phlebography , Radiation Injuries/surgery , Radioisotope Teletherapy , Superior Vena Cava Syndrome/surgeryABSTRACT
Most cases of superior vena cava (SVC) syndrome are secondary to malignant disease and subacute in their presentation. Acute cases of SVC syndrome have been described, with the majority of these being precipitated by thrombosis after central venous catheterization. The authors report a case of acute SVC syndrome after central venous catheter placement, which was not due to thrombosis, but rather caused by a catheter occluding a previously subclinical stenosis of the SVC. Resolution of the clinical SVC syndrome occurred after catheter withdrawal.
Subject(s)
Catheterization, Central Venous/adverse effects , Superior Vena Cava Syndrome/etiology , Acute Disease , Aged , Constriction, Pathologic/etiology , Female , Humans , Vena Cava, Superior/radiation effectsABSTRACT
To examine the acute influences of irradiation on the anastomotic sites of EPTFE vascular grafts, an experimental study was performed using dogs. After replacement of superior vena cava and bilateral femoral arteries with EPTFE grafts, a total of 20 to 100 Gy doses were given at the anastomotic sites of superior vena cava and right femoral artery. There was no degradation of grafts themselves or rupture in the anastomoses at cumulative radiation doses of 20 to 100 Gy. However, in many dogs, receiving over 50 Gy doses at the anastomotic sites of superior vena cava, stenoses and/or overgrowth of granulation tissues were observed, although at those of right femoral artery, no remarkable differences were observed between dogs which received and those which did not receive irradiation.
Subject(s)
Blood Vessel Prosthesis , Femoral Artery/surgery , Polytetrafluoroethylene/radiation effects , Vena Cava, Superior/surgery , Anastomosis, Surgical , Animals , Dogs , Femoral Artery/radiation effects , Vena Cava, Superior/radiation effectsSubject(s)
Mediastinal Neoplasms/radiotherapy , Radiotherapy Dosage , Vena Cava, Superior/radiation effects , Adolescent , Adult , Aged , Carcinoma, Bronchogenic/radiotherapy , Carcinoma, Squamous Cell/radiotherapy , Child , Constriction, Pathologic/radiotherapy , Female , Humans , Lung Neoplasms/radiotherapy , Lymphoma/radiotherapy , Male , Mediastinal Neoplasms/complications , Middle AgedABSTRACT
The treatment of a superior vena caval obstruction associated with a mediastinal mass is a true radiotherapeutic emergency. The heralding signs and symptoms and the morbidity of the syndrome justify beginning therapy before a pathologic diagnosis is established. In a series of 19 patients with superior vena cava syndrome, there was an excellent response to an initial high-dose course of irradiation, consisting of 400 rads midplane for 3 days, then reduced to conventional daily fractionation. It is concluded that rapid high-dose irradiation in the treatment of a superior vena cava syndrome is safe and effective.
