[Accelerated hyperfractionation radiation therapy combined with chemotherapy for non-small cell lung cancer complicated with superior vena cava syndrome].
OBJECTIVE
This retrospective study was done to evaluate the patient's tolerance and effect of accelerated hyperfractionation radiation therapy in the treatment of superior vena cava syndrome (SVCS) caused by non-small cell lung cancer (NSCLC).


METHODS
Thirty-four NSCLC patients complicated with SVCS were treated between January 1992 and September 1996. Their ages ranged from 36-78 years (median 57). There were 30 (88.2%) male and 4(11.8%) female patients. Dyspnea (67.6%) and facial swelling (52.9%) were the two most common symptoms. Engorgement of neck veins (38.2%) and dilated chest wall veins (28.5%) were the most common physical findings. According to their pathological diagnosis, there were 17(50%) squamous cell carcinomas, 14(41.2%) adenocarcinomas, 2(5.9%) mixed squamous and adenocarcinomas and 1(2.96%) poorly differentiated carcinomas. By thoracic CT scans, a mass was most commonly found in the right upper lobe and the upper mediastinum. For these patients, chemotherapy IEP or IAP (IFO 2.0 g d1-4, DDP 40 mg d1-3, Vp-16 0.1 g d1-3 or ADM 50 mg d1) was given first. Twenty-four to 72 hours after chemotherapy, accelerated hyperfractionation radiation therapy was started to deliver to the primary tumor and the metastatic mediastinal lymph nodes, a tumor dose of 30 Gy/20 fx/2 wk followed by a boost to 36-40.8 Gy/30-34 fx/3-3.5 wk. Diuretics, steroids and dehydrating agents were concomittantly prescribed during the radiation therapy.


RESULTS
Relief of SVCS to various degrees was noted in all patients. CR, PR and MR rates were 20.6% (7/34), 50% (17/34) and 29.4% (10/34), respectively. The median survival was 12 months (4-26 months). The 1-2 year actuarial survival rates were 58.1% and 18.2% Except radio-esophagitis in different degrees, no other severe complications were observed.


CONCLUSIONS
The fraction and total dose of radiotherapy are tolerable in this accelerated hyperfractionation trial. Radiation therapy combined with chemotherapy gives similar results as non-surgery for stage III NSCLC. No significant difference in the survival rates of the various histological types is observed.
Ye
M
M
Department of Radiation Oncology, Cancer Hospital, Shanghai Medical University, Shanghai 200032, China.
Wang
L
L
Fu
X
X
D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D012189:Retrospective Studies; D013479:Superior Vena Cava Syndrome / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000532:radiotherapy*; D015996:Survival Rate; D016896:Treatment Outcome