SUPERIOR VENA CAVA SYNDROME

Differential Diagnosis

  • 80% bronchogenic carcinoma
  • 10-18% malignant lymphoma
  • 2-3% benign cases (e.g., goiter)

Workup

Less Severe Syndrome and No Severe Respiratory Distress

  • CT chest
  • bronchoscopy
  • biopsy of tumor

Full Blow SVC Syndrome and Severe Respiratory Distress

  • emergency therapy without tissue diagnosis
  • For unknown diagnosis assume NSCLC and start
    • RT (3-4 Gy x 2-3 days) followed by 1.8-2.0 Gy to complete definitive RT (60-70 Gy)
  • For patients with diagnosis of SCLC either RT or chemotherapy are effective

Prognosis

  • 70% with either good or excellent symptomatic relieve of SVC syndrome with radiation
  • OS-2 of 10-20%
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