Radiotherapy in superior vena cava-syndrome - Retrospective follow-up and review of the literature.

Background: In consideration of the tumor histology radiotherapy is the tre atment of choice in patients with superior vena cava-syndrome (SVCS). This is a retrospective study to evaluate the efficacy of irradiation and to dis cuss the treatment schedule with regard to adequate palliation in patients presenting with SVCS and systemically advanced tumor stage causing a poor p rognosis. Patients: Twelve patients were irradiated for SVCS between 6/93 a nd 12/96 in the Department of Radiotherapy of the Johann Wolfgang Goethe-Un iversitat Frankfurt/Main. Primary tumor histology included eight lung cance rs, two breast cancers, one oropharyngeal cancer, and one thyroid cancer. T he patients' range of ages was from 39-80 years (mean age 54,9+/-14 years). A total dose of 49-54 Gy (initially 3-7x3 Gy/day, followed by 2 Gy/day) wa s delivered to the mediastinum +/- supraclavicular area. Visceral metastase s were diagnosed in ten patients. Results: At initiation of radiotherapy, f our patients had grade II-SVCS and eight grade III-SVCS (clinical grading b y Perez-Soler et at. 1984). The SVCS was diagnosed 17-153 days (median 36 d ays) prior to irradiation. Two patients had previously been treated with ch emotherapy. Eleven patients experienced improvement of their symptoms withi n 7+/-2 days. Median survival from the initiation of radiotherapy was 154 d ays (21-297 days) in patients with grade II-SVCS and 56 days (24-91 days) i n patients with grade III-SVCS. Three patients did not complete their radio therapy (death 6-9 days later). One patient had a recurrence of SVCS and an other died from local complications of SVCS. Conclusions: The results of th is retrospective analysis are comparable with our review of the literature. Radiotherapy provides an early effective palliation of SVCS, whereas survi val depends on clinical symptoms, histology, and extent of the disease. The refore, in patients with a poor prognosis, regardless of the histology, red uction of the total dose to 30-36 Gy should be considered.