TREATMENT OF MALIGNANT SUPERIOR VENA-CAVA OBSTRUCTION - METAL STENTS OR RADIATION-THERAPY

PURPOSE: The results of treating malignant superior vena cava obstruct ion by means of percutaneous self-expanding stent insertion or by mean s of radiation therapy were compared. PATIENTS AND METHODS: Seventy-si x patients with malignant superior vena cava obstruction who were trea ted by stent insertion were studied prospectively and 25 patients who were treated by radiation therapy were studied retrospectively A super ior vena cava obstruction score was devised to measure treatment effec tiveness, Speed of symptom relief and complications were recorded, End points in the study were recurrent obstruction or death, Asymptomatic survival times were compared by log rank and Mann Whitney tests of si gnificance, as well as Kaplan-Meier analysis, A subgroup of 26 patient s who were treated by stent placement only were compared with the radi ation therapy group and analyzed separately. RESULTS: There were seven complications in the overall stent group, one in the stent-only group , and 25 in the radiation therapy group, Stent insertion provided fast er relief of symptoms and significantly greater improvement in the sup erior vena cava obstruction score than radiation therapy (P < .001, Ma nn-Whitney U test), A Kaplan-Meier analysis of asymptomatic survival d emonstrated that significantly fewer patients in the overall and stent -only groups developed recurrent symptoms (P = .0005 and 001, respecti vely, log rank test). CONCLUSION: This study suggests that percutaneou s stent insertion in malignant superior vena cava obstruction fulfills the requirements of a palliative procedure significantly better than radiation therapy and that it should be the procedure of first choice.