Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus
Editorial Group: Cochrane Lung Cancer Group
Published Online: 23 OCT 2001
Assessed as up-to-date: 29 JUL 2001
Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Rowell NP, Gleeson FV. Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD001316. DOI: 10.1002/14651858.CD001316.
- Publication Status: Edited (no change to conclusions)
- Published Online: 23 OCT 2001
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.
To determine the relative effectiveness of treatments currently employed in the management of SVCO.
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.
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.
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.
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.
Plain language summary
Insertion of a stent improves symptoms in superior vena cava obstruction caused by lung cancer, while chemotherapy and radiotherapy can also be effective
Lung cancer sometimes obstructs a vein close to the heart, the vena cava, causing swelling in the chest, face and arms. Treatments to try to reduce the obstruction include chemotherapy (anticancer drugs), radiotherapy (radiation treatment), stents (metal sleeves inserted inside a vein to keep it open) and steroid drugs to decrease swelling. This review found that insertion of a stent improved symptoms in over 90% of patients (but the best time to use them is unclear), whereas chemotherapy and radiotherapy relieved symptoms in about 60%-70% of patients. The effectiveness of steroids is unknown.
電子資料庫的搜尋包含了the Cochrane Central Register of Controlled Trials (CENTRAL, 2001 Issue 2), MEDLINE和EMBASE。最近一次的搜尋是在2001年7月。並由前述電腦搜尋所得資料進一步找出被引用的研究。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
支架置放術能改善肺癌造成的上腔靜脈阻塞的症狀；化學治療和放射線治療的效果也是有效。 肺癌有時候會阻塞靠近心臟的靜脈，如腔靜脈，造成胸部、臉以及手臂的腫脹。治療的方法包括化學治療、放射線治療、支架置放術以及給予類固醇，這些都是用來減少阻塞進而減少腫脹。這篇回顧發現支架置放可以改善超過90%病人的症狀，但是最好的置放時間未明；而化學治療和放射線治療可以改善60% – 70%病人的症狀。類固醇的療效則未明。