Intervention Review

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

  1. Nick P Rowell1,*,
  2. Fergus V Gleeson2

Editorial Group: Cochrane Lung Cancer Group

Published Online: 23 OCT 2001

Assessed as up-to-date: 29 JUL 2001

DOI: 10.1002/14651858.CD001316


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.

Author Information

  1. 1

    Maidstone Hospital, Kent Oncology Centre, Maidstone, Kent, UK

  2. 2

    Churchill Hospital, Department of Clinical Radiology, Headington, Oxford, UK

*Nick P Rowell, Kent Oncology Centre, Maidstone Hospital, Hermitage Lane, Maidstone, Kent, ME16 9QQ, UK. nrowell@nhs.net.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 OCT 2001

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

類固醇,放射線治療,化學治療,以及支架置放術在支氣管腫瘤所造成的上腔靜脈阻塞治療的比較

上腔靜脈阻塞是支氣管腫瘤不常見的表現,它的特徵是脖子腫脹和胸部靜脈擴張,治療的選擇包括了放射線治療,化學治療,類固醇以及金屬支架置放術

目標

評估目前用來處理上腔靜脈阻塞的方法的成效

搜尋策略

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。

選擇標準

隨機和非隨機試驗,病人都是有支氣管腫瘤和被診斷為上腔靜脈阻塞的病人,且曾以類固醇,放射線治療,化學治療,或支架置放術合併治療者。

資料收集與分析

總共有3個隨機和98個非隨機試驗,其中分別有2個和44個試驗符合條件

主要結論

10%的小細胞肺癌的病人和1.7%的非小細胞肺癌的病人在診斷時就表現有上腔靜脈阻塞。在非隨機試驗中發現在小細胞肺癌病人,化學治療加或amdlor放射線治療可以解除77%病人的上腔靜脈阻塞;但是有17%的病人會再復發。在非小細胞肺癌病人,化學治療加或放射線治療可以解除60%病人的上腔靜脈阻塞;有19%的病人會再復發。在上腔靜脈中置放支架可以解除95%病人的上腔靜脈阻塞;11%的病人會再復發,重新打通後有92%的病人可以做到長期通暢。如果有給溶栓劑,支架置放導致的併發症率較高。沒有研究提及類固醇用在上腔靜脈阻塞的療效。

作者結論

雖然化學治療和放射線治療能有效解決上腔靜脈阻塞,但是支架置放術能提供更快的解決。支架置放術最好的時間(在診斷當下或者是其他療法失敗時)和類固醇的效力仍未確定。

翻譯人

本摘要由臺北榮民總醫院葉尚倫翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

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。