Radiation Oncology/SVC Syndrome/Randomized

Randomized Evidence for Superior Vena Cava Syndrome

• Sao Paolo, 1999 (Brazil) Abstract "Neoadjuvant chemotherapy vs radiotherapy alone for superior vena cava syndrome (SVCS) due to non-small cell lung cancer (NSCLC): preliminary results of randomized phase II trial." (Pereira JR, Eur J Cancer 1999;35(Suppl 4):260.
  • Randomized. Terminated early due to larger number of treatment-related deaths in chemo arm. 34 patients with NSCLC. Treated with immediate RT + cisplatin vs. cisplatin/epirubicin/vinblastine. Info from PMID 12555872
  • Outcome: no difference in relief or survival, but larger number of treatment-related deaths in chemotherapy-only arm

• London (UK)(no dates given) -- SCLC: chemo +/- RT
  • Randomized. 37/366 patients with SCLC enrolled in trial of chemotherapy +/- RT presented with SVC obstruction. 9 relapsed during chemo and were not randomized. Induction chemotherapy (adriamycin + vincristine + cyclophosphamide alternating with cyclphosphamide + MTX) x4 cycles then randomized Arm 1) RT 40/20 AP/PA vs. Arm 2) continued chemotherapy. Both consolidated with 8 cycles of chemotherapy
  • 1983 PMID 6310812 -- "Treatment of obstruction of the superior vena cava by combination chemotherapy with and without irradiation in small-cell carcinoma of the bronchus. (Spiro SG, Thorax. 1983 Jul;38(7):501-5.)
    • Outcomes: After induction chemo, 21/37 (57%) CR, 10/37 (27%) PR of SVC symptoms. Median OS identical.
    • Conclusion: Chemo alone effective for SVC; no benefit for consolidative RT induction chemo x4 cycles

• Oklahoma/Virginia -- high dose RT vs. nitrogen mustard + RT
  • Randomized. 28 patients with SVC syndrome, 22 completed treatment. Arm 1) nitrogen mustard 0.4 mg/kg, then in 3-8 days RT 40-50 Gy in 1.5-2.0 Gy/fx vs. Arm 2) RT only (4 Gy/fx until drop in venous pressure at least 30 mm H2O or 20 Gy, then 2 Gy/fx for total 40-50 Gy), diuretics as necessary. Tumor + 1cm margin. Delivered by 2 MeV Van de Graaff unit.
  • 1969 PMID 4898825 -- "Treatment of malignant superior vena caval obstruction. A randomized study." (Levitt SH, Cancer. 1969 Sep;24(3):447-51.)
    • Outcome: Time to venous pressure drop (NS), relief of symptoms (NS), duration of relief (NS), recurrence (NS), OS (NS)
    • Toxicity: Combined arm more severe complications
    • Conclusion: No difference between groups, suggest initially high daily dose