Review of evolving etiologies, implications and treatment strategies for the superior vena cava syndrome.
Review of evolving etiologies, implications and treatment strategies for the superior vena cava syndrome.
复制标题
DOI：
10.1186/s40064-016-1900-7
复制
发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Kim DW
中科院分区：
文献类型：
--
作者：
Straka C;Ying J;Kong FM;Willey CD;Kaminski J;Kim DW
上腔静脉综合征（SVCS）是一种相对常见的纵隔恶性肿瘤的后遗症，可引起显著的病人痛苦。如果伴有喉水肿或脑水肿，SVCS是一种急诊。随着时间的推移，SVCS的病因和治疗已经发生了变化。非恶性SVCS通常由感染性病因或上腔静脉血栓引起，可分别通过抗生素或抗凝治疗进行治疗。放射治疗（RT）长期以来一直是治疗恶性SVCS的主要方法。化疗也被用于治疗SVCS。在过去的20年里，经皮上腔静脉支架置入术已成为SVCS症状缓解的可行选择。放疗和化疗仍然是唯一的方式，可以提供根治性治疗的潜在恶性病因的SVCS。第一次用放疗治疗SVCS的经验是在20世纪70年代报道的，随后在放疗方面取得了一些进展。对患者来说，低分级放疗可能是一种更方便的治疗方法，并可能对潜在的恶性肿瘤提供同等或更好的控制。RT可与支架植入和/或化疗联合使用，以提供即时症状缓解和长期疾病控制。临床医生应该根据具体情况量身定制治疗方案。多学科护理将最大限度地提高治疗的方便性和疗效。
Superior vena cava syndrome (SVCS) is a relatively common sequela of mediastinal malignancies and may cause significant patient distress. SVCS is a medical emergency if associated with laryngeal or cerebral edema. The etiologies and management of SVCS have evolved over time. Non-malignant SVCS is typically caused by infectious etiologies or by thrombus in the superior vena cava and can be managed with antibiotics or anti-coagulation therapy, respectively. Radiation therapy (RT) has long been a mainstay of treatment of malignant SVCS. Chemotherapy has also been used to manage SVCS. In the past 20 years, percutaneous stenting of the superior vena cava has emerged as a viable option for SVCS symptom palliation. RT and chemotherapy are still the only modalities that can provide curative treatment for underlying malignant etiologies of SVCS. The first experiences with treating SVCS with RT were reported in the 1970’s, and several advances in RT delivery have subsequently occurred. Hypo-fractionated RT has the potential to be a more convenient therapy for patients and may provide equal or superior control of underlying malignancies. RT may be combined with stenting and/or chemotherapy to provide both immediate symptom palliation and long-term disease control. Clinicians should tailor therapy on a case-by-case basis. Multi-disciplinary care will maximize treatment expediency and efficacy.