Federico Laurel Ampil MD, Presenter: Nothing to Disclose

Gloria Caldito PhD, Abstract Co-Author: Nothing to Disclose

Carlos Humberto Previgliano MD, Abstract Co-Author: Nothing to Disclose

James S. Welsh MD, MS, Abstract Co-Author: Speakers Bureau, TomoTherapy Incorporated Owner, Radion, Inc Consultant, Coqui Radioisotopes

Roxana Baluna MD, PhD, Abstract Co-Author: Nothing to Disclose

Traditionally, emergency’ palliative radiotherapy (EPRT)  has been recommended for superior vena caval obstruction  (SVCO) by a malignant tumor because the clinical condition is considered life-threatening on account of the associated distressful symptoms and signs.  Although a commonly held and important tenet, it is a debatable subject.  We retrospectively analyzed our experience of lung cancer (LCa) patients with SVCO who were referred for EPRT during the past 29 years to determine the importance of EPRT timing.

A review of the radiation oncology data base during the period between September 1981 and April 2009 was performed to find the people with SVCO-LCa.  Forty-two identified individuals were classified into two groups: those who underwent irradiation on the day of referral (group A, 16 patients) and those who were treated several days after the radiation oncology consultation (group B, 26 patients). Study endpoints were response to treatment and survival.

The predominant histologic tumor type was non-small cell lung cancer (71%).  The most common clinical manifestations of SVCO were facial/neck/upper limbs swelling (71%), dyspnea (50%) and chest or abdominal wall venous collaterals (43%). None of the patients exhibited stridor or obtundation. The duration of symptoms and signs prior to radiation oncology consultation was ≥2 weeks in the majority (77%) of cases. The overall median survival (MS) was 4 months, and 1-year crude survival rate (CSR) 21%. Among the evaluable individuals, the complete, partial and absent objective response rates were 67%, 19% and 14% respectively. The MS was 3 months for group A and 6 months for group B; the corresponding 1-year CSRs were 13% and 31%. The complete objective response rates were 50% and 82% in the absence or presence of venous collateralization respectively.

Irradiation of patients with SVCO-LCa is efficacious in providing palliation, but the mandate for the immediate administration of radiotherapy is not supported by the observations from this retrospective study.

The need for immediate chest radiotherapy for SVCO-LCa remains appropriate when the trachea is obstructed or cerebral edema develops as a result of intracranial venous hypertension.

Ampil, F, Caldito, G, Previgliano, C, Welsh, J, Baluna, R, "Emergency" Palliative Radiotherapy for Superior Vena Caval Obstruction by Lung Cancer: Is Timing Crucial?.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11000548.html