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44 - Diagnosis and Management of Superior Vena Cava Syndrome
- from PART IV - SPECIALIZED INTERVENTIONAL TECHNIQUES IN CANCER CARE
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- By Robert J. Lewandowski, Assistant Professor, Department of Radiology Section of Interventional Radiology Robert H. Lurie Comprehensive Cancer Center Northwestern Memorial Hospital Chicago, IL, Bassel Atassi, Research Associate, Department of Radiology Section of Interventional Radiology Robert H. Lurie Comprehensive Cancer Center Northwestern Memorial Hospital Chicago, IL, Riad Salem, Associate Professor, Department of Radiology Robert H. Lurie Comprehensive Cancer Center Northwestern Memorial Hospital Chicago, IL
- Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
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- Book:
- Interventional Oncology
- Published online:
- 18 May 2010
- Print publication:
- 15 September 2008, pp 552-562
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Summary
BACKGROUND
Superior vena cava (SVC) syndrome, first described in 1757 by William Hunter (1), refers to a constellation of clinical symptoms caused by obstruction of the SVC. This obstruction is nearly always (>85%) attributable to advanced malignancy (2, 3), most commonly lung cancer. In fact, SVC syndrome affects 3% to 4% of patients with bronchogenic cancer (4). Other primary thoracic malignancies, lymphoma and metastatic disease (particularly from breast and testicular primaries) have also been implicated in SVC syndrome either secondary to extrinsic compression of the SVC or due to direct tumor invasion (2). Benign causes of SVC syndrome include venous stenoses, thrombosis (secondary to vascular access catheters and invasive monitoring devices), extrinsic compression from thoracic aortic aneurysms and mediastinal fibrosis from granulomatous disease (5).
The diagnosis of SVC syndrome is initially made clinically. SVC syndrome is characterized by congestion and swelling of the face and upper thorax, with distended superficial chest veins. Other associated symptoms include dyspnea, hoarseness, dysphagia, severe headache and cognitive dysfunction (6, 7). The most severe complications of SVC syndrome include glottic edema and venous thrombosis in the central nervous system (venous stroke). Contrast-enhanced computed tomography (CT) of the chest with vascular reconstruction images should be obtained in these patients, as it can both confirm the site of SVC obstruction as well as delineate the cause of the obstruction (8). Alternatively, magnetic resonance imaging (MRI) can be obtained in those patients with contraindications to CT. The gold standard for diagnosing SVC syndrome is venography.
24 - Radioembolization with 90Yttrium Microspheres for Colorectal Liver Metastases
- from PART III - ORGAN-SPECIFIC CANCERS
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- By Bassel Atassi, Research Associate, Department of Radiology Section of Interventional Radiology Robert H. Lurie Comprehensive Cancer Center Northwestern Memorial Hospital Chicago, IL, Saad Ibrahim, Research Fellow, Robert H. Lurie Comprehensive Cancer Center Northwestern Memorial Hospital Chicago, IL, Pankit Parikh, Research Assistant, Northwestern Memorial Hospital Chicago, IL, Robert K. Ryu, Associate Professor, Department of Radiology Northwestern Memorial Hospital Chicago, IL, Kent T. Sato, Assistant Professor, Department of Radiology Northwestern Memorial Hospital Chicago, IL, Robert J. Lewandowski, Assistant Professor, Department of Radiology Section of Interventional Radiology Robert H. Lurie Comprehensive Cancer Center Northwestern Memorial Hospital Chicago, IL, Riad Salem, Associate Professor, Department of Radiology Robert H. Lurie Comprehensive Cancer Center Northwestern Memorial Hospital Chicago, IL
- Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
-
- Book:
- Interventional Oncology
- Published online:
- 18 May 2010
- Print publication:
- 15 September 2008, pp 280-289
-
- Chapter
- Export citation
-
Summary
90Yttrium (90Y) microspheres are 20- to 40-μ particles that emit beta radiation. Because the microspheres are delivered via the hepatic arterial route, the process can be considered “internal” rather than external radiation. The treatment algorithm is analogous to that followed with transarterial chemoembolization (TACE). Clinical history, physical examination, laboratory values and performance status are obtained. Patients are initially evaluated and staged using cross-sectional imaging techniques (computerized tomography [CT], magnetic resonance imaging [MRI], positron emission tomography [PET]). Once a patient is considered a possible candidate for therapy, evaluation using mesenteric angiography followed by treatment on a lobar basis is undertaken. Patients are followed clinically to assess toxicities and response prior to proceeding with treatment to the other lobe. A comprehensive review of the technical and methodological considerations in 90Y has been previously published (1–3).
Two devices are commercially available. Thera- Sphere (glass) was approved in 1999 by the Food and Drug Administration (FDA) under a Humanitarian Device Exemption (HDE) for the treatment of unresectable hepatocellular carcinoma (HCC) in patients with or without portal vein thrombosis who can have appropriately positioned hepatic arterial catheters (4). SIR-Spheres (resin) were granted full pre-marketing approval in 2002 by the FDA for the treatment of colorectal metastases in conjunction with intrahepatic floxuridine (FUDR) (5). Both devices have European approval for liver neoplasia and approvals in various Asian countries.
OVERVIEW
Patients with metastatic cancer to the liver from a colorectal primary tumor may be treated using surgical resection alone, providing a chance for long-term cure.