Radiotherapy for SVC syndrome - PowerPoint Presentation

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Radiotherapy for SVC syndrome

Somvilai

Chakrabandhu

, MD.

Division of Therapeutic Radiology and Oncology,

Faculty of Medicine, Chiang Mai University

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DefinitionThe

clinical manifestation

of obstruction of the superior vena cava, with severe reduction in venous return from the head, neck, and upper extremities

SVC syndrome

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SVC syndrome

Superior

vena

cavacarries venous blood from the head, arms, and upper trunk to the heart

carries

approximately one third of the venous return to the heart.

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Obstruction of Superior vena cava Reduction in venous return of face, neck, upper extremities

Collateral development of venous system

-

azygos, internal thoracic, paraspinous

,

esophageal

SVC syndrome

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Types of SVC obstruction Extrinsic compression Mediastinal structure or lymph nodes

Intrinsic obstruction

Thrombosis Neoplastic infiltration

SVC syndrome

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Causes of SVC obstruction Malignant about 80% Lung cancerLymphoma

Metastasis malignancy to

mediastinal LNs Non-malignancy

Infection (stphilis, TB)Fibrosis Thrombus (central venous catheter)

SVC syndrome

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Dyspnea

(most common)

Orthopnea Facial / Neck swelling

Cough

hoarseness

Headache

Nasal congestion

Hemoptysis

Dysphagia

Dizziness

Syncope

SVC syndrome

Symptoms

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The severity of the symptoms depends on the degree of narrowing of the superior vena cavaSymptom onset depends on speed of SVC obstruction onsetMalignant disease can arise in weeks to months

Not enough time to develop collaterals

SVC syndrome

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Physical findingEdema of face, arms

Dilated neck veins

Increased collateral veins over anterior chest wall

Cyanosis

Severe cases include

proptosis

,

glossal

and laryngeal edema

SVC syndrome

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Wilson L et

al.N

Engl J Med

2007;356:1862-9

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Radiographic Studies

Chest x-ray

Most

common findingsMediastinal wideningPleural effusion

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CT Chest with contrastPreferred choicedefines the level of obstructionMaps out collateral pathways

Can differentiate between vena

caval thrombosis and extrinsic compression

Radiographic Studies

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Radiographic Studies

CT scan : Diagnosis level of obstruction

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MRI useful in patients with IV contrast allergies

Positronemission

tomography (PET) sometime useful

Radiographic Studies

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ManagementSuperior vena cava syndrome associated with malignant conditions involves both treatment of the cancer and

relief of the symptoms of obstruction

SVC syndrome

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Emergency condition Stridor

from laryngeal edema and impending airway obstruction

Confusion related to associated cerebral edema

SVC syndrome

Immediate action is needed

Attention to the ABCs assessment

Stabilize the airway

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Non- Emergency conditionMost patients are not in immediate danger at presentation

Sit upright : relief of the usual

dyspnea

Oxygen support, if indicated Consider steroids

SVC syndrome

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Treatments & interventionsMedical management :

Corticosteroid and diuretic for laryngeal and cerebral edema (controversy)

Thrombolytic drug : thrombotic cause

SVC syndrome

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Treatments & interventionsSurgical treatment : bypass Endovascular stent

increasingly used

immediate relief symptom

Refractory to RT/ chemotherapy

SVC syndrome

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Treatments & interventionsRT and chemotherapy

Relief symptom and

Treatment malignancy

SVC syndrome

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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

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Radiation Therapy

Radiation dose for palliation

20 - 30 Gy

in 5 – 10 fractions Depend on patient conditionRadiation field Encompass

mediastinal

lymph nodes /

hilar region

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Radiation Therapy

Supine position

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E- consult & Refer

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E- consult & Refer

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Thank you