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Oncological Emergencies (Superior Vena Cava Syndrome (Treatment (SVCS in…

- - - - Small cell lung carcinoma (38%)
        
        Squamous cell lung carcinoma(26%)
        
        Lymphoma(8%):diffuse large cell lymphoma or lymphoblastic lymphoma
        
        Thymoma
        
        Germ cell tumors
        
        Breast cancer in metastatic stage
    - - SVC thrombosis in the era intravascular
        devices (central vein catheters, pacemakers)
    - - Jatrogenic causes (cardiovascular surgery, SVC catheterization for parenteral nutrition)
        
        Lymphomas
        
        ALL
  - - - Chemotherapy: RR(response rate)=93 %, usually used as initial modality , treatment of choice
        
        Radiotherapy: RR=94%
        
        the risk of SVCS recurrence significantly lower when CHT+RT
        
        Relief after 7-10 days
    - - Chemotherapy: RR=59%
        
        Radiotherapy: RR=64%
        
        Endovascular stent insertion
    - - No treatment modality was superior in achieving clinical improvement
        
        Rarely an emergency
        
        Complete staging work-up before! therapy
        
        Chemotherapy = treatment of choice
        
        Consolidation radiotherapy – large cell lymphoma with mediastinal masses ≥ 10 cm
    - - Optional treatment for most pts with SVCS
        
        Initial treatment if histologic diagnosis can not be established and the clinical status of the patient is deteriorating
        
        Fractination schedule: 20Gy/5 fractions or 30Gy/10 fractions
        
        Treatment volume: gross tumor, mediastinal,hilar +/- supraclavicular lymph nodes
        
        Altarnative to paliative RT: endovascular stenting +/- thrombolysis
    - - Considered ONLY after other therapeutic maneuvers with RT, CHT and stenting have been exhausted in case of malignancy-induced SVCS
        
        Experience - limited
    - - Bed rest with the head elevated
        
        Oxygen administration 3-4L/M
        
        Diuretic therapy
        
        Reduced-salt diet
        
        Steroids (6-10 mg dexamethasone PO or IV every 6 hours)
- - - - volume changes in brain parenchyma: primary or secondary brain tumors, edema, indirect neurological complications of cancer
        
        vasogenic edema: ↑ leakage of plasma filtrate into brain tissue through leaky capillaries of the brain tumor
        
        cytotoxic edema: ischemic injury, cytotoxic chemotherapy agents
        
        break down of the ADP- dependent transmembranous ion transport system → intracellular entrapment of water
        
        imbalance between cerebrospinal fliud production and absorption:
        mass lesions in proximity to bottlenecks of CSF flow → obstructive or noncommunicating hydrocephalus
        carcinomatosis or meningitis block CSF reabsorption
    - - brain metasatses:
        adults: lung cancer, breast cancer, melanoma
        children: RMS, Ewing sarcoma
        associated with hemorrhage: melanoma, choriocarcinoma, renal cell carcinoma, papillary thyroid carcinoma
    - - Dural venous sinus thrombosis
        
        Metastases at the base of skull
        
        Mediastinal masses