title: Double-flash, large-fraction radiation therapy as palliative treatment of malignant superior vena cava syndrome in the elderly.
abstract: Rapid control of symptoms is mandatory in cancer-induced superior vena cava syndrome (SVCS), but older patients often do not tolerate aggressive approaches. In order to maximize symptom relief and minimize treatment-related discomfort of aged patients in poor health we adopted a short-course, large-fraction radiation therapy (RT) schedule. Twenty-three consecutive patients aged over 70 who were suffering from solid-malignancy-related SVCS were enrolled. A total dose of 12 Gy was given in two 6-Gy fractions, 1 week apart, mainly in an out-patient setting. Completion of therapy to give up to 37-40 Gy was planned in the best-responding patients. Symptom relief was experienced by 8 patients as early as 4-5 days after the first fraction. The overall response rate was 87%. Despite some mild systemic side effects (chest pain, fever) reported by 5 patients (22%), overall toxicity was negligible. Short-course, double-flash RT stands as an effective and safe tool in the palliative treatment of malignant SVCS in older patients. Fractions larger than 6 Gy can be avoided in order to minimize side and toxic effects.
authors.affiliation: Unità di Radioterapia Oncologica, Ospedale Civile ASL 21, 37045 Via Gianella, 1, Legnago (Verona), Italy. rtlegnago@hotmail.com
authors.forename: Federico
authors.initials: F
authors.lastname: Lonardi
authors.forename: Gloria
authors.initials: G
authors.lastname: Gioga
authors.forename: Graziella
authors.initials: G
authors.lastname: Agus
authors.forename: Manuela
authors.initials: M
authors.lastname: Coeli
authors.forename: Franco
authors.initials: F
authors.lastname: Campostrini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications / Q000401:mortality / Q000532:radiotherapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000401:mortality / Q000532:radiotherapy; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000532:radiotherapy; D018450:Disease Progression; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000401:mortality / Q000532:radiotherapy; D008297:Male; D010166:Palliative Care; D011879:Radiotherapy Dosage; D012720:Severity of Illness Index; D013479:Superior Vena Cava Syndrome / Q000209:etiology / Q000401:mortality / Q000532:radiotherapy*; D016019:Survival Analysis; D016896:Treatment Outcome