Stent Implantation for Superior Vena Cava Syndrome of Malignant Cause

Our plain-English summary of Stent Implantation for Superior Vena Cava Syndrome of Malignant Cause, by F.A. Büstgens, R. Loose, J.H. Ficker, et al (RöFo, 2017).

The study

• Authors: F.A. Büstgens, R. Loose, J.H. Ficker, M. Wucherer, M. Uder, R. Adamus
• Journal: RöFo
• Published: 2017;189(5):423-430
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose The purpose of this paper is the retrospective analysis of endovascular therapy for the treatment of superior vena cava syndrome (SVCS) of malignant cause. This study focuses on the effectiveness of the therapy regarding the duration of remission, symptom control and practicability. Materials and Methods From January 2003 to November 2012, therapeutic implantation of one or more stents was performed in 141 patients suffering from SVCS. The medical history was retrospectively researched using digitalized patient files. If those were incomplete, secondary research was conducted using the cancer registry of the General Hospital Nuremberg, the cancer registry of the tumor center at Friedrich-Alexander-University Erlangen-Nuremberg (FAU) or information given by physicians in private practice. This data was collected using Microsoft Office Excel® and statistically analyzed using IBM SPSS Statistics 22®. Results 168 stents were implanted in 141 patients (median age: 64.6 years; range: 36 - 84), 86 being male and 55 being female. In 121 patients, SVCS was caused by lung cancer (85.8 %), in 9 patients by mediastinal metastasis of an extrathoracic carcinoma (6.4 %), in 3 patients by mesothelioma of the pleura (2.1 %) and in 1 patient by Hodgkin's disease (0.7 %). There was no histological diagnosis in 7 cases (4.9 %). The primary intervention was successful in 138 patients (97.9 %). Immediate thrombosis in the stent occurred in the remaining 3 cases. Recurrence of SVCS was observed in 22 patients (15.6 %), including 5 early and 17 late occlusions. Stent dislocation or breakage was not observed. As expected, the survival after implantation was poor. The median survival was 101 days, and the median occlusion-free survival was 80 days. Conclusion The symptomatic therapy of SVCS with endovascular stents is effective and safe. Despite effective symptom control and a low rate of recurrence, the patients' prognosis is poor. Key Points: · Patients with SVCS of malignant cause have a poor prognosis.. · Lung cancer is the most common cause for SVCS.. · Endovascular therapy is safe and effective.. Citation Format · Büstgens FA, Loose R, Ficker JH et al. Stent Implantation for Superior Vena Cava Syndrome of Malignant Cause. Fortschr Röntgenstr 2017; 189: 423 - 430.

© Georg Thieme Verlag KG Stuttgart · New York.

In plain English

This retrospective study from the General Hospital Nuremberg, Germany, reviewed 141 patients who received stents between January 2003 and November 2012 for superior vena cava syndrome, a blockage of the large vein draining the head and arms, caused by cancer. Asbestos exposure was not examined. Lung cancer caused the blockage in 121 patients. Three patients had pleural mesothelioma, and their results were not reported separately. Good drainage was seen after stenting in 138 patients (97.9 %). Three had immediate clotting in the stent, and another died the same day of acute right heart failure. The syndrome returned in 22 patients (15.6 %): 5 within 30 days and 17 later. 27 patients (19 %) died within 30 days, and median survival after the procedure was 101 days (based on 130 patients). Among small-cell lung cancer patients, those stented before diagnosis lived a median of 326 days after diagnosis, versus 209 days for those stented after. The authors used this split as a stand-in for syndrome present at diagnosis, because onset dates were unavailable. The authors concluded that stenting is safe and well tolerated but that prognosis remains poor.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective single-center review of patients treated with stents (case series)
• Who was studied: 141 patients (86 men, 55 women; median age 64.6 years, range 36 to 84) with superior vena cava syndrome of malignant cause, stented at the General Hospital Nuremberg, Germany, January 2003 to November 2012
• Exposure: Treatment with self-expanding endovascular stents (168 stents in primary interventions). Asbestos or fiber exposure was not studied.
• Main results:
  • Causes of the syndrome: 121 lung cancers (64 small-cell, 56 non-small-cell, 1 undifferentiated). The other causes were 9 extrathoracic carcinomas with mediastinal metastases, 3 pleural mesotheliomas and 1 case of Hodgkin's disease. Seven patients had no histological diagnosis.
  • Pleural mesothelioma was the cause in 3 of 141 patients (2.1 %).
  • Good drainage through the stented vessel was seen in 138 of 141 patients (97.9 %). Stent breakage or dislocation was not observed.
  • Three patients had immediate occlusions from clot in the stent.
  • One patient developed acute right heart failure after the procedure and died the same day.
  • The syndrome recurred in 22 patients (15 %). Five recurrences came within the first 30 days (median 17 days) and 17 came later (median 128 days).
  • Patency of the primarily implanted stents at days 30, 60, 180, 365 and 730 was 95.2, 94.0, 83.7, 85.7 and 85.7 %, as printed.
  • 27 patients (19 %) died within the first 30 days after the procedure.
  • Median overall survival after the procedure was 101 days, based on 130 patients. Median relapse-free survival was 80 days, based on 131 patients.
  • Among small-cell lung cancer patients, the authors split the group by whether stenting came before or after histological diagnosis, as a stand-in for syndrome present at diagnosis versus syndrome that began later. Those stented before diagnosis had a median survival of 326 days after initial diagnosis. Those stented after diagnosis had a median of 209 days (p = 0.012, log rank). This was not shown for non-small-cell lung cancer.
  • No statistically significant difference in survival was shown between emergency and elective stenting. Emergency patients had median relapse-free survival of 80 days and overall survival of 83 days; elective patients had 92 and 106 days.
• The authors' conclusion: The authors concluded that stenting is a safe and well-tolerated method with a low risk profile for quick and lasting relief of symptoms, but that the prognosis of these patients remains poor.
• Limitations the authors state:
  • For late occlusions, tumor thrombosis could not be ruled out because no histological confirmation was done.
  • There were no data on when the syndrome first appeared, so the authors used the timing of the procedure relative to histological diagnosis as a substitute measure.
  • The authors had experience with only a few cases using other access routes (transcubital and transjugular).

Topics

Medical terms in this study, explained in our Lexicon: Superior Vena Cava Syndrome, Cancer Registry, Lung Cancer, Metastasis, Carcinoma, Mesothelioma, Pleura, Median Overall Survival.

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