SVC Dosing

[medicineradman]

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I have a 68 yo man presented with a 7 cm lung lesion causing SVC syndrome, only symptoms are slight cough no real SOB/DOE, no reason for urgent treatment. Overall healthy. He does have widespread mets unfortunately. Path is most likely Squamous NSCLC. What would your management be at this point. Would you treat the primary mass that is causing SVC palliatively to get him on to systemic tx? What dose/frac?

 

[Palex80]

Probably squamous NSCLC means no targetted therapy as first line treatment. Thus it's chemo for this patient down the road.
If the other mets do not present an immediate problem right now, I would advocare to irradiate first and then go on to chemo.

30/3-39/3 are typical fractionation schedules, you can however increase dose per day if you wish to do so (for example 24/4 or 20/5).

 

[Gfunk6]

If eligible for chemo, agree with Palex. Would treat 30/10 or 20/5 followed by chemo

 

[medgator]

If med oncs are giving carbo/taxol, I've been OK with Txing 37.5/15 during chemo depending on the volume.

 

[OTN]

30 Gy in 10 fx

 

[napoleondynamite]

For something that big, I'd personally go a little higher. I like 45/15 for a case like that.

 

[medicineradman]

Turns out this guy cant lie flat even with oxygen; hasn't been sleeping flat for the last month. At rest sitting up though he is ok, 96% on room air. They fitted him for 3 L O2 with exertion.

What would you do in this situation? Start with chemo? Endovascular stent to bridge to RT then to chemo? He has a good amount of central lung disease which may account for this orthopnea, on bronch they saw a lot of secretions at the level of the carina.

 

[seper]

I would try to set him up for XRT on inclined table.

 

[Palex80]

Try a breast board. 🙂