1. Radiotherapy for SVC syndrome
Somvilai Chakrabandhu, MD.
Division of Therapeutic Radiology and Oncology,
Faculty of Medicine, Chiang Mai University

2. SVC syndrome Definition
The clinical manifestation of obstruction of the superior vena cava, with severe reduction in venous return from the head, neck, and upper extremities

3. SVC syndrome Superior vena cava
carries venous blood from the head, arms, and upper trunk to the heart
carries approximately one third of the venous return to the heart.

4. SVC syndrome Obstruction of Superior vena cava
Reduction in venous return of face, neck, upper extremities
Collateral development of venous system
- azygos, internal thoracic, paraspinous,
esophageal

5. SVC syndrome Types of SVC obstruction Extrinsic compression
Mediastinal structure or lymph nodes
Intrinsic obstruction
Thrombosis
Neoplastic infiltration

6. SVC syndrome Causes of SVC obstruction Malignant about 80%
Lung cancer
Lymphoma
Metastasis malignancy to mediastinal LNs
Non-malignancy
Infection (stphilis, TB)
Fibrosis
Thrombus (central venous catheter)

7. SVC syndrome Symptoms Dyspnea (most common) Orthopnea
Facial / Neck swelling
Cough
hoarseness
Headache
Nasal congestion
Hemoptysis
Dysphagia
Dizziness
Syncope

8. SVC syndrome
The severity of the symptoms depends on the degree of narrowing of the superior vena cava
Symptom onset depends on speed of SVC obstruction onset
Malignant disease can arise in weeks to months
Not enough time to develop collaterals
As the obstruction develops venous collaterals are formed

9. SVC syndrome Physical finding Edema of face, arms Dilated neck veins
Increased collateral veins over anterior chest wall
Cyanosis
Severe cases include proptosis, glossal and laryngeal edema

10. Wilson L et al.N Engl J Med 2007;356:1862-9

11. Radiographic Studies Chest x-ray Most common findings
Mediastinal widening
Pleural effusion

12. Radiographic Studies CT Chest with contrast Preferred choice
defines the level of obstruction
Maps out collateral pathways
Can differentiate between vena caval thrombosis and extrinsic compression

13. Radiographic Studies
CT scan : Diagnosis level of obstruction

14. Radiographic Studies MRI useful in patients with IV contrast allergies
Positronemission tomography (PET)
sometime useful

15. SVC syndrome Management
Superior vena cava syndrome associated with malignant conditions involves both
treatment of the cancer and
relief of the symptoms of obstruction

16. Immediate action is needed
SVC syndrome
Emergency condition
Stridor from laryngeal edema and impending airway obstruction
Confusion related to associated cerebral edema
Immediate action is needed
Attention to the ABCs assessment
Stabilize the airway

17. SVC syndrome Non- Emergency condition
Most patients are not in immediate danger at presentation
Sit upright : relief of the usual dyspnea
Oxygen support, if indicated
Consider steroids
Controversial issue with regards to treatment benefit at presentation

18. SVC syndrome Treatments & interventions Medical management :
Corticosteroid and diuretic for laryngeal and cerebral edema (controversy)
Thrombolytic drug : thrombotic cause

19. SVC syndrome Treatments & interventions Surgical treatment : bypass
Endovascular stent
increasingly used
immediate relief symptom
Refractory to RT/ chemotherapy

20. SVC syndrome Treatments & interventions RT and chemotherapy
Relief symptom and
Treatment malignancy

21. Radiation Therapy Excellent symptom relief:
dyspnea
edema of face and
distention of neck and thoracic vein
Symptomatic improvement usually takes 1-2 weeks after radiotherapy

22. Radiation Therapy Radiation dose for palliation Radiation field
Gy in 5 – 10 fractions
Depend on patient condition
Radiation field
Encompass mediastinal lymph nodes / hilar region

23. Radiation Therapy
Supine position

24. E- consult & Refer

25. E- consult & Refer

26. Thank you