Treatment of Malignant Superior Vena Cava Obstruction: Metal Stents or Radiation Therapy

Abstract

The results of treating malignant superior vena cava obstruction by means of percutaneous self-expanding stent insertion or by means of radiation therapy were compared. Seventy-six patients with malignant superior vena cava obstruction who were treated by stent insertion were studied prospectively and 25 patients who were treated by radiation therapy were studied retrospectively. A superior vena cava obstruction score was devised to measure treatment effectiveness. 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 significance, as well as Kaplan-Meier analysis. A subgroup of 26 patients who were treated by stent placement only were compared with the radiation therapy group and analyzed separately. 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 faster relief of symptoms and significantly greater improvement in the superior vena cava obstruction score than radiation therapy (P < .001, Mann-Whitney U test). A Kaplan-Meier analysis of asymptomatic survival demonstrated that significantly fewer patients in the overall and stent-only groups developed recurrent symptoms (P = .0005 and .001, respectively, log rank test). This study suggests that percutaneous 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.