Unraveling the superior vena cava syndrome conundrum in lung cancer patients, a retrospective multivariate analysis – A tertiary care center venture

Abstract

BACKGROUND: Need to address superior vena cava syndrome (SVCS) is essential since SVCS has the potential to be fatal if not treated as an emergency. MATERIALS AND METHODS: Forty histologically confirmed patients with SVCS due to lung cancer treated from January 2015 to December 2020 were taken up for the study. Two groups of patients received two different radiation regimens for SVCS: Treatment 1:300 cGy per fraction for 10 fractions (40%, n = 18) and Treatment 2:400 cGy per fraction for 5 fractions (52.5%, n = 22). These two groups were analyzed in terms of clinical outcomes based on tumor and treatment characteristics and their association with symptom reduction and treatment response in SVCS in lung cancer patients. RESULTS: The mean survival for Treatment 1 is 6.6 months and Treatment 2 is 8 months but is not a statistically significant difference (P = 0.587; confidence interval [CI] 95%). The mean symptom reduction for Treatment 1 is within 10.1 days and for Treatment 2 is within 5.6 days, which is statistically significant (P = 0.001; CI 95%). Overall survival for patients whose symptoms reduced after treatment is 9.85 months while for patients where no symptom reduction is 1.2 months, which is statistically significant (P = 0.0005; CI 95%). CONCLUSION: Radiotherapy (RT) regimen of 400 cGy per fraction for 5 fractions is superior to 300 cGy per fraction for 10 fractions regimen in terms of rate of SVCS symptom reduction. patients whose SVCS symptoms improved after planned RT has better overall survival. Whereas progression/nil improvement/incompletion of planned RT have poorer prognosis in terms of overall survival.

Keywords

• clinical outcomes
• lung
• prognosis
• superior vena cava
• superior vena cava obstruction