Hypofractionated radiation therapy in the treatment of superior vena cava syndrome.

We retrospectively reviewed 46 patients with superior vena cava syndrome during the period 1986-1992. The common symptoms included congestion of collateral veins of the neck, anterior chest wall, face, eyelids and right arm. Dyspoea and cyanosis occurred less frequently. In all but two patients a histological diagnosis was made by invasive and non-invasive examination without complications. In 82% of all patients a primary lung carcinoma was the cause of the superior vena cava syndrome. For 39 patients radiotherapy was the first treatment of choice. To relieve the distressing symptoms patients received one of two regimens employing hypofractionated radiotherapy. In regimen 3F, 25 patients received three weekly high dose fractions of 8 Gy delivering a total dose of 24 Gy. Regimen 2F, applied to seven patients, consisted of two weekly fractions of 8 Gy, giving a total of 24 Gy. In both regimens a good palliative result was established, however the results of the 3F regimen were superior. Using the 3F regimen a partial response was obtained in 96% of all patients, and 56% achieved a complete response. With the 2F regimen a partial response was achieved in 70% of all patients, and a complete response in only 28%. Minimal side effects were noted. After reviewing our experience, the 3F regimen is recommended for rapid and effective relief of the superior vena cava syndrome.