Comparison between 1-week and 2-week palliative radiotherapy courses for superior vena cava syndrome

Abstract

Purpose: The aim of this study was to evaluate the effectiveness of palliative radiation therapy (RT) for superior vena cava (SVC) syndrome from lung cancer and to compare the 2-week and 1-week schedules.Materials and Methods: A retrospective study was conducted on lung cancer patients with palliative RT for SVC syndrome. Patients received 30 Gy in 10 fractions (2-week group) or 20 Gy in 5 fractions (1-week group) between July 2012 and June 2022. Treatment outcomes were evaluated at 1 to 2 months after RT. The tumor response and recanalization were evaluated based on the computed tomography (CT).Results: Of the 39 patients, 24 received a 2-week course RT and 15 received a 1-week course of RT. The most common SVC-associated symptoms were edema (51.3%) and dyspnea (43.6%). There were no significant differences in performance status, histology, and grade of SVC. Symptom relief in symptomatic patients was comparable (85.7% in the 2-week group vs. 91.6% in the 1-week group; p = 0.581). There were no significant differences between the 2-week and 1-week groups in recanalization rates (62.5% vs. 60.0%; p = 0.876), tumor responses (75% vs. 60.0%; p = 0.876), and 6-month overall survival rates (29.2% vs. 36.4%; p = 0.726). In each of the two groups, one patient was consulted for re-irradiation. The median survival were 3.7 months for the 2-week group and 4.4 months for the 1-week group. Conclusion: In patients with SVC syndrome, the palliative effect of a 1-week course was equivalent to that of a 2-week course. Given the poor prognosis, a 1-week course may be an option.

Surgical resection of an intraluminal tumor in the azygos vein with an unknown primary site causing superior vena cava syndrome

“…11 Recently, palliative radiotherapy has been reported to be an effective management with a high clinical success rate of approximately 90%. 12,13 Endovascular stenting has a similarly high clinical success rate of over 90%, and is often considered the first-line treatment because it provides more rapid symptom resolution than radiation therapy or chemotherapy. 2,13 However, these methods were previously unsuccessful in treating patients with malignant SVC syndrome, who reported medial survival times of less than 6 months and who mostly died of cancer-specific causes.…”

“…2,13 However, these methods were previously unsuccessful in treating patients with malignant SVC syndrome, who reported medial survival times of less than 6 months and who mostly died of cancer-specific causes. 12,13 SVC resection and reconstruction are considered the treatment of choice for SVC invasion by lung malignancies, especially for those without lymph node involvement, with reported median survival times of up to 12 months and 5-year survival rates of 30%-50%, compared with 5% for radiotherapy. [14][15][16] Additionally, although surgeries can be technically challenging and operative mortalities of mediastinal tumors invading the SVC can be up to 10%, operative mortalities of cardiac tumor are reported to be less than 1%.…”

“…Recently, palliative radiotherapy has been reported to be an effective management with a high clinical success rate of approximately 90% 12,13 . Endovascular stenting has a similarly high clinical success rate of over 90%, and is often considered the first‐line treatment because it provides more rapid symptom resolution than radiation therapy or chemotherapy 2,13 .…”

“… 2 , 13 However, these methods were previously unsuccessful in treating patients with malignant SVC syndrome, who reported medial survival times of less than 6 months and who mostly died of cancer‐specific causes. 12 , 13 …”