Superior vena cava syndrome radiation therapy: Difference between revisions
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{{Superior vena cava syndrome}} | {{Superior vena cava syndrome}} | ||
{{CMG}} | {{CMG}}{{AE}}{{MV}} | ||
==Overview== | |||
Rapid radiotherapy is recommended for all patients who develop superior vena cava syndrome secondary to malignant tumor. The feasibility of radiation therapy depends on the stage of cancer at diagnosis. Radiation dosage will depend on a basis of clinical features. | |||
==Radiation Therapy== | |||
==Indications== | |||
The feasibility of radiation therapy depends on the stage of cancer at diagnosis. If the obstruction caused by the SVCS is caused by a [[tumor]] that is not sensitive to [[chemotherapy]], radiation therapy is indicated | |||
== | ===Emergent RT=== | ||
*RT prior to biopsy can obscure histologic diagnosis. | |||
*Endovascular stents in severely symptomatic patients provide more rapid relief | |||
*Consider Emergency RT (and endovascular stent) if: | |||
**Stridor from severe laryngeal edema | |||
**Coma from cerebral edema | |||
===RT dose/schedule=== | |||
Initially use high-dose fractions (3-4 Gy) for 2 or 3 days if treating curatively to 60-70Gy, followed by standard 1.8-2 Gy/fx | |||
*Not unusual to palliate with 3Gy x 10, or 4Gy x 5 or 2.5Gy x 15 | |||
*Symptomatic relief can be apparent in 72 hours, complete relief can be seen by 2 weeks (78% SCLC, 63% NSCLC) | |||
*SVCS patency improvement only in 31%, so some symptom relief probably due to development of collateral circulation over time | |||
*Many patients will recur symptomatically prior to death | |||
*Consider Chemotherapy before or with RT if: | |||
**SCLC, NHL & germ cell tumors | |||
**In the absence of distant metastasis, aggressive management is indicated | |||
**Symptomatic relief within the first 30 days might be a good prognostic factor | |||
**Treatment with larger fractions of [[radiation]] is thought to be beneficial in developing a rapid response. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Hematology]] | [[Category:Hematology]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Revision as of 20:33, 13 January 2016
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Superior Vena Cava Syndrome Microchapters |
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Differentiating Superior Vena Cava Syndrome from Other Diseases |
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Risk calculators and risk factors for Superior vena cava syndrome radiation therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Overview
Rapid radiotherapy is recommended for all patients who develop superior vena cava syndrome secondary to malignant tumor. The feasibility of radiation therapy depends on the stage of cancer at diagnosis. Radiation dosage will depend on a basis of clinical features.
Radiation Therapy
Indications
The feasibility of radiation therapy depends on the stage of cancer at diagnosis. If the obstruction caused by the SVCS is caused by a tumor that is not sensitive to chemotherapy, radiation therapy is indicated
Emergent RT
- RT prior to biopsy can obscure histologic diagnosis.
- Endovascular stents in severely symptomatic patients provide more rapid relief
- Consider Emergency RT (and endovascular stent) if:
- Stridor from severe laryngeal edema
- Coma from cerebral edema
RT dose/schedule
Initially use high-dose fractions (3-4 Gy) for 2 or 3 days if treating curatively to 60-70Gy, followed by standard 1.8-2 Gy/fx
- Not unusual to palliate with 3Gy x 10, or 4Gy x 5 or 2.5Gy x 15
- Symptomatic relief can be apparent in 72 hours, complete relief can be seen by 2 weeks (78% SCLC, 63% NSCLC)
- SVCS patency improvement only in 31%, so some symptom relief probably due to development of collateral circulation over time
- Many patients will recur symptomatically prior to death
- Consider Chemotherapy before or with RT if:
- SCLC, NHL & germ cell tumors
- In the absence of distant metastasis, aggressive management is indicated
- Symptomatic relief within the first 30 days might be a good prognostic factor
- Treatment with larger fractions of radiation is thought to be beneficial in developing a rapid response.