General Approach to Treatment

Because the majority of SVCS is not immediately life- threatening, a tissue diagnosis (if malignancy is unknown) to specifically identify the cancer origin is critical since treatment approaches vary considerably according to tumor histology. Thus, therapy can typically be withheld until a definitive tissue diagnosis is established. While biopsy results are pending, supportive measures such as head elevation, diuretics, cor-ticosteroids and supplemental oxygen may be utilized.

Nonpharmacologic Therapy

Radiation therapy is the treatment of choice for chemo-therapy-resistant tumors such as nonsmall cell lung cancer (NSCLC) or in chemotherapy- refractory patients with SVCS. Between 70% and 90% of patients will experience relief of symptoms. Radiation therapy may also be combined with chemotherapy for chemotherapy-sensitive tumors such as SCLC and lymphoma. In the rare emergency situations of airway obstruction or elevated ICP, empiric radiotherapy prior to tissue diagnosis should be used. In most patients, symptoms resolve within 1 to 3 weeks.

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