Journal of Clinical Oncology, Vol 2, 961-969, Copyright © 1984 by American Society of Clinical Oncology
A reassessment of the clinical implications of the superior vena caval syndrome
FR Ahmann
For the past 30 years patients presenting with the superior vena caval
syndrome (SVCS) have, as a recommended practice, been treated with
radiotherapy without necessarily establishing a tissue diagnosis. This
practice has been pursued as it was accepted that the probability that
unresectable lung cancer was the cause of the syndrome was high; that SVCS
was a condition for which diagnostic procedures carried a high risk; and
that SVCS was a life-threatening situation requiring immediate relief. To
assess the validity of this practice, the literature since 1934 was
reviewed. One thousand nine hundred eighty- six cases of reported SVCS were
identified resulting in the emergence of several important facts: (1) small
cell lung cancer is currently the leading etiology of SVCS accounting for
approximately 40% of all cases due to lung cancer; (2) the experience with
performing thoracotomies, mediastinoscopies, bronchoscopies, lymph node
biopsies, and venograms as reported in the literature suggests that all of
these diagnostic procedures can be performed safely; (3) while the SVCS can
cause worrisome symptomatology, there is little reported clinical or
experimental evidence that an unrelieved SVCS is life threatening; and (4)
patency of the SVCS may not be reestablished after palliative therapy even
though signs and symptoms may resolve. Because of therapeutic advances in
the treatment of small cell lung cancer, lymphoproliferative disorders, and
other malignant etiologies of the SVCS, the findings of this review suggest
that a policy of treatment without histologic diagnosis is ill advised.
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