[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.

CONCLUSION: 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.