Treatment/Prognosis Flashcards
What is the 1st step in Tx of SVC syndrome?
The 1st step in treating SVC syndrome is to establish a pathologic Dx, which will determine further interventions.
What Tx may be used for SVC syndrome?
SVC syndrome Tx: RT, chemo, Sg, and stents
What supportive measures can be taken to manage SVC syndrome?
Elevation of head of bed and supplemental oxygen. Diuretics can be used for cerebral edema. Remove indwelling catheter if SVC syndrome due to thrombosis. (McCurdy M et al., Crit Care Med 2012)
What is the role of steroids in SVC syndrome?
Steroids are frequently used in SVC syndrome, but there are limited data to support their use except in lymphoma and thymoma.
In which malignant causes of SVC syndrome is chemo 1st-line Tx?
Chemo is the Tx of choice in SVC syndrome caused by lymphoma, germ cell tumors, and SCLC.
What is the most rapid way to manage SVC thrombosis?
The most rapid method to manage SVC thrombosis is by intraluminal stenting.
What Tx should be considered if a pt with SVC syndrome presents with thrombosis?
Use anticoagulation therapy for pts with SVC syndrome presenting with thrombosis unless contraindications are present.
Which pts with SVC syndrome require emergent Tx?
SVC syndrome pts with central airway compromise, severe laryngeal edema, or altered mental status/coma secondary to cerebral edema require emergent Tx.
What fractionation is used to emergently treat SVC syndrome?
Fractionation for emergent SVC Tx is 3–4 Gy × 3 fx. There are conflicting retrospective data on the benefit of hypofractionation.
When treating SVC syndrome, what should the RT fields encompass?
RT fields for SVC syndrome include encompassing gross Dz and adjacent nodal tissue while respecting normal tissue toxicity, esp the lungs and heart.
What should guide the total RT dose used for SVC syndrome?
The total RT dose for SVC syndrome depends on the underlying histology (i.e., lung cancers are treated to ≥60 Gy, while lymphomas are treated to 35–45 Gy). Palliative regimens such as 3 Gy × 10 may also be appropriate depending on the overall clinical status.
Does SVC syndrome portend a bad prognosis?
Not necessarily. The prognosis in SVC syndrome depends on the underlying cause rather than the presence of the syndrome itself. MS is about 6 mos for cancer-induced SVC syndrome. However, based on etiology, many will survive longer or even be cured.
What is the overall symptomatic response to RT in SVC syndrome?
The ORR to RT for SVC syndrome is ∼60%.
Over what approximate timeline can pts expect Sx relief from RT?
Normally, response time to RT is 7–15 days, but in some cases, relief may be experienced as soon as 72 hrs. (Wan J et al., Emerg Med Clin N Am 2009)
Does RT for SVC syndrome restore normal flow in the SVC?
No. RT for SVC syndrome does not generally restore normal vascular flow despite improving Sx.
