title: Urothelial Superior Vena Cava Syndrome with Limited Response to Radiation Therapy.
abstract: Radiation therapy (RT) is the standard of care for cases of superior vena cava (SVC) syndrome secondary to metastatic adenopathy. Histologies vary in radiosensitivity and response time, making alternative therapies such as chemotherapy and/or intravenous stenting preferable alternative options for certain diagnoses. Metastatic urothelial carcinoma is a particularly rare cause of SVC syndrome with only 3 cases reported in the literature. Consequently, optimal management remains challenging, particularly in cases of high tumor burden. Here we present a case of highly advanced metastatic urothelial cancer with SVC syndrome and tracheal compression. The patient started urgent RT but expired midway through her treatment course due to systemic progression of disease, requiring SVC and tracheal stenting. The authors review the literature including discussion of the few other known cases of SVC syndrome due to urothelial carcinoma and a review of this histology's response to RT. This experience suggests, that in cases of SVC syndrome with widespread advanced disease, stenting and chemotherapy with or without RT may be the most important initial treatment plan, depending on goals of care.
authors.affiliation: University of Vermont College of Medicine, 89 Beaumont Avenue, Burlington, VT 05405, USA.
authors.forename: Nishan
authors.initials: N
authors.lastname: Bingham
authors.affiliation: Division of Radiation Oncology, University of Vermont Cancer Center, 111 Colchester Avenue, Mailstop 301SH2, Burlington, VT 05401, USA.
authors.forename: H James
authors.initials: HJ
authors.lastname: Wallace Iii
authors.affiliation: Division of Hematology Oncology, University of Vermont Cancer Center, 89 Beaumont Avenue, Suite E-214, Burlington, VT 05405, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Monterroso
authors.affiliation: Division of Hematology Oncology, University of Vermont Cancer Center, 89 Beaumont Avenue, Suite E-214, Burlington, VT 05405, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Verschraegen
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, 111 Colchester Avenue Main Campus, East Pavilion, Burlington, VT 05401, USA.
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Waters
authors.affiliation: Division of Radiation Oncology, University of Vermont Cancer Center, 111 Colchester Avenue, Mailstop 301SH2, Burlington, VT 05401, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Anker