Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus

Abstract

Background: Superior vena caval obstruction (SVCO) is an uncommon manifestation of carcinoma of the bronchus characterised by neck swelling and distended veins over the chest. Treatment options include radiotherapy, chemotherapy, steroids and insertion of an expandable metal stent. Objectives: To determine the relative effectiveness of treatments currently employed in the management of SVCO. Search methods: Electronic searching of the Cochrane Central Register of Controlled Trials (CENTRAL, 2001 Issue 2), MEDLINE and EMBASE. Date of latest searches: July 2001. Identification of further studies from references cited in trials identified by electronic searching. Selection criteria: Both randomised and non-randomised trials in which patients with carcinoma of the bronchus and a diagnosis of SVCO had been treated with any combination of steroids, chemotherapy, radiotherapy or insertion of an expandable metal stent. Data collection and analysis: There were 3 randomised and 98 non-randomised studies of which 2 and 44 respectively met the inclusion criteria. Main results: SVCO was present at diagnosis in 10.0% of patients with SCLC and 1.7% of patients with NSCLC. Non-randomised trials showed that, in SCLC, chemotherapy and/or radiotherapy relieved SVCO in 77%; 17% of those treated had a recurrence of SVCO. In NSCLC, 60% had relief of SVCO following chemotherapy and/or radiotherapy; 19% of those treated had a recurrence of SVCO. Insertion of an SVC stent relieved SVCO in 95%; 11% of those treated had further SVCO but recanalisation was frequently achieved resulting in long-term patency in 92%. Morbidity following stent insertion was greater if thrombolytics were administered. No study described the effectiveness of steroids in SVCO. Authors' conclusions: Chemotherapy and radiotherapy are effective in relieving SVCO in a proportion of patients whereas stent insertion appears to provide relief in a higher proportion and more rapidly. The optimal timing of stent insertion (whether at diagnosis or following failure of other modalities) and the effectiveness of steroids remain uncertain.