Intrathoracic complications of malignancy and its treatment

Obstruction of the superior vena cava is seldom a true emergency and should not be treated without an adequate tissue diagnosis. For patients who are poor operative risks for invasive procedures, percutaneous biopsies of mediastinal masses under ultrasound guidance have resulted in a high diagnostic yield. Superior vena caval syndrome secondary to thrombosis is increasing as venous access devices are used more commonly, and it is important that the catheter should be positioned well down in the vena cava to prevent thrombotic complications. Talc remains the best agent to achieve sclerosis of the pleural cavity, but doxycycline and minocycline are also quite effective replacements for tetracycline, which is no longer available. Radiation-induced pneumonitis and esophagitis continue to limit the total dose and the field that may be administered within the thoracic cavity. As combined modality treatment programs are developed and as doses of chemotherapeutic agents and radiation are both intensified, steps must be taken to ensure that the added toxicity of such treatment can be justified by a significantly superior outcome.