The efficacy evidence for this protocol comes from the systematic review by Rowell et al. which included patients utilising radiation therapy or chemotherapy to relieve symptoms of superior vena cava obstruction (SVCO).r
SVCO is considered an oncological emergency if it is associated with laryngeal or cerebral oedema.rr However, immediate radiation therapy is not indicated as a first line treatment when stenting is feasible.r Management of superior vena cava syndrome associated with malignant disease involves both the treatment of the cancer and relief of the symptoms of the obstruction. The use of radiation therapy is widely advocated for symptom management of SVCO. Chemotherapy may be an alternative to radiation therapy for chemosensitive malignancies e.g. small cell lung cancer.
There are no randomised trials comparing the efficacy of stents with palliative radiation therapy or systemic chemotherapy in the setting of SVCO.
The systematic review by Rowell et al reported on the comparative efficacy of these approaches in patients with SVCO due to either small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC).r In patients with SCLC (n = 600), radiation therapy or chemotherapy resulted in complete or partial relief in 77% of patients, with SVCO recurring 17% of the time. In patients with NSCLC (n = 150), radiation therapy or chemotherapy resulted in complete or partial relief in 60% of patients, with SVCO recurring in 19% of patients. It was reported that superior vena cava stents relieved the symptoms of SVCO in 95% of patients, with a recurrence of SVCO in 11% of patients.
The optimal timing of stent insertion and the effectiveness of steroids remains unclear.