Cause of Superior Vena Cava Syndrome in Cancer Determines Prognosis
In patients with cancer caused primarily by the growth of tumoral lymph nodes, SVCS is common.
The prognosis of cancer patients with superior vena cava syndrome (SVCS) is highly associated with the underlying cause, according to a study published in Supportive Care in Cancer.
SVCS is a commonly occurring condition in patients with cancer caused primarily by the growth of tumoral lymph nodes or masses in the middle or anterior mediastinum. Patients may experience complications such as laryngeal edema, cerebral edema, upper airway compression, cardiac infiltration by malignancy, cardiac tamponade, and pleural effusion, leading to poor outcomes.
For this retrospective study, researchers identified 50 patients with cancer with SVCS who were admitted to the intensive care unit (ICU) presenting with respiratory, hematologic, or neurologic instability.
All patients underwent computed tomography (CT) scans, which revealed that two-thirds of study patients had partial obstructions of the superior vena cava, and one-third had complete obstructions.
In 70% of cases, radiologic interventions were utilized to reveal the cause of SVCS. Chest CT scans showed that 36% of patients had upper airway compression and 44% of patients had pericardial effusions. Sixty-seven percent of patients had pleural effusion, 32% had atelectasis, and 10% had pulmonary embolisms.
Thirty percent of patients required invasive mechanical ventilation, 14% received vasopressors, and 6% initiated renal replacement therapy.
The only factor independently associated with day 180 mortality was the cause of SVCS.
Patients with SVCS had ICU, in hospital, and 6-month mortality rates of 20%, 26%, and 48%, respectively.
Of patients with SVCS, 60% had hematologic malignancies, 40% had solid tumors, and had mortality rates of 27%, and 80%, respectively (odds ratio, 0.12; 95% CI, 0.02-0.60; P <.01).
1. Morin S, Grateau A, Reuter D, et al. Management of superior vena cava syndrome in critically ill cancer patients [published online August 24, 2017].Support Care Cancer. doi: 10.1007/s00520-017-3860-z