Uperior vena cava syndrome (svcs) was first described in l757 in a patient with a syphilitic

Radiation

Indications.

The majority of cases of SVCS are

caused by malignancy; thus, most patients receive radi-

ation treatment at some point in their illness. Emer-

gency radiation treatment has been administered to

some patients with life-threatening cerebral or laryn-

geal edema prior to a tissue diagnosis of malignancy.

The relief of obstructive symptoms by radiation thera-

py may provide sufficient time to work up the cause of

SVCS, thus allowing for more specific treatment.

Radiotherapy for the treatment of a thoracic malignan-

cy or lymphoma may be appropriate, whereas radio-

therapy for the treatment of an underlying thrombosis

or granulomatosis causing the obstruction would be

inappropriate. Therefore, delaying treatment for 1 to 

2 days if necessary to establish a firm tissue diagnosis is

appropriate. 

Dosage.

Radiation treatment is initiated at high-

dose fractions daily for the first few days. This treat-

ment regimen is usually followed by conventional low

daily doses. The total dose is dependent on the

underlying tumor histology. Lymphomas are general-

ly treated with 3000 to 4000 cGy, whereas carcinomas

require 4000 to 5000 cGy or more to achieve control.

Lower doses of radiation treatment may be consid-

ered in cases in which systemic disease is present and

short-term palliation is the goal. Because of the limit-

ed tolerance of the heart and spinal cord to radiation,

short duration, high-dose programs are used. Physi-

cians must be aware of this dosage intensity in treat-

ing patients who are receiving chemotherapeutic

agents such as doxorubicin, which can enhance radia-

tion toxicity.

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