PURPOSE: Superior vena cave syndrome (SVCS) is an association with a variety of benign and malignant etiologies. The aim of this study was to evaluate if malignant SVCS is a real medical emergency or we are able to obtain a definite histological diagnosis before chemoradiotherapy.
METHODS: In this prospective case series study, we have evaluated epidemiologic characteristics and ability to obtain a definitive histologic diagnosis before chemoradiotherapy and the role of chemoradiotherapy before obtaining tissue specimen on the results of diagnostic interventions in patients with malignant SVCS who came to thoracic surgery wards of Imam Khomeini (Tehran), Ghaem and Imam Reza (Mashhad) hospitals -IRAN from 2001 to 2006.
RESULTS: Among 50 patients with SVCS, M/F ratio was 32/18. Mean age was 61.7 years and the most common symptom was dyspnea (86%). We performed successful tissue sampling before chemoradiotherapy in 44 cases (88%) and histologic diagnosis was established in 100% of these cases but among other 6 patients (12%) who received chemoradiotherapy first because unstable general conditions, histologic diagnosis was obtained only in one patient 16.7% of these cases after chemoradiotherapy (P<0.01).
CONCLUSION: As we are able to stablish tissue specimen by minimally invasive methods in most SVCS cases and as chemoradiatine may preclude obtaining exact pathologic diagnosis so we suggest performing diagnostic interventions prior to chemoradiation in patients with SVC syndrome.
CLINICAL IMPLICATIONS: The SVCS is encountered commonly in association with a variety of benign and malignant etiologies. For malignant etiologies, histologic diagnosis is essential for the institution of appropriate management . Although previous medical literatures were believed that sudden, dramatic occlusion of the SVC and the azygos system would result in so-called wet brain syndrome with development of cerebral edema secondary to venous obstruction .Roswitt et al also believed that emergent irradiation with or without chemotherapy would be inevitable in this situation but some authors recently have reported very low mortality for SVCS. So the role of emergent chemoradiotherapy in SVCS has become controversial.
DISCLOSURE: Reza Bagheri, No Financial Disclosure Information; No Product/Research Disclosure Information