Conci Nicole, Grilli Giada, Dall'Olio Filippo G
Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Via Giuseppe Massarenti, Bologna, Italy.
Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
Mediastinum. 2022 Dec 25;6:35. doi: 10.21037/med-21-54. eCollection 2022.
Giant mediastinal tumors are represented by well-defined histological variants originating from different structures and compartments while their clinical presentation may be similar and characterized by the same set of symptoms, the well-known mediastinal syndrome (MS). In 80% of cases the MS is caused by malignant neoplasms, such as lung tumors, in 10-18% of cases by hematological neoplasms and in 2-3% by benign causes. In this review we investigated the medical treatment of main giant mediastinal tumors, focusing our interest on the objective response rate (ORR), as it represents the most suitable parameter to predict the volumetric reduction of the neoplasm and, consequently, the regression of their most severe complication, the MS. We will also cover the supportive and symptomatic treatment of MS.
We performed a deep analysis of the recent international literature published on PUBMED, UpToDate and Medline. The literature search was undertaken from origin until November 30th, 2021, and we only considered publications in English.
Considering the variety of pathologies that can occur in the mediastinum, a rapid histological characterization of the neoplasm is mandatory. In fact, the treatment of these neoplasms includes different approaches, sometimes used in combination, which include chemotherapy, radiotherapy, and surgery. The vena cava syndrome (VCS), due to its high mortality, is considered an oncological emergency and, therefore, requires effective treatments carried out urgently, evaluated in multidisciplinary meeting.
The treatment of MS includes both antiblastic treatments and therapies directed to the symptoms. Among the former, chemotherapy, target therapy, radiation and surgery may be used, according to the etiology of MS. Among the latters, supportive therapies, interventional radiology procedures such as stenting may help manage this syndrome, despite the prognosis is poor in most cases and linked to the histology of the tumor, which therefore represents the most important prognostic factor.
巨大纵隔肿瘤表现为源自不同结构和腔隙的组织学特征明确的变异型，但其临床表现可能相似，以一组相同的症状为特征，即众所周知的纵隔综合征（MS）。在80%的病例中，MS由恶性肿瘤引起，如肺部肿瘤；在10% - 18%的病例中由血液系统肿瘤引起；在2% - 3%的病例中由良性原因引起。在本综述中，我们研究了主要巨大纵隔肿瘤的医学治疗方法，重点关注客观缓解率（ORR），因为它是预测肿瘤体积缩小以及随之而来的最严重并发症MS消退的最合适参数。我们还将涵盖MS的支持性和对症治疗。
我们对发表在PUBMED、UpToDate和Medline上的近期国际文献进行了深入分析。文献检索从起始时间至2021年11月30日，我们仅考虑英文出版物。
鉴于纵隔可能出现的多种病理情况，对肿瘤进行快速组织学特征鉴定至关重要。事实上，这些肿瘤的治疗包括不同方法，有时联合使用，包括化疗、放疗和手术。由于其高死亡率，腔静脉综合征（VCS）被视为肿瘤急症，因此需要在多学科会议上评估后紧急进行有效治疗。
MS的治疗包括抗增殖治疗和针对症状的治疗。在前者中，根据MS的病因，可使用化疗、靶向治疗、放疗和手术。在后者中，支持性治疗、介入放射学程序如支架置入术可能有助于管理该综合征，尽管在大多数情况下预后较差且与肿瘤组织学相关，因此肿瘤组织学是最重要的预后因素。
