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• W2171085877 abstract "Purpose/Objective: Short-course, large-fraction radiation therapy (LFRT) is mostly used to palliate bone metastases in both advanced-cancer and older patients (pts). Fear still exists that inner soft tissue organs can hardly tolerate LFRT, especially in aged pts or pts with reduced functional reserves. We investigated the clinical effectiveness and tolerance of a double-flash LFRT as first-line approach to the superior vena cava syndrome (SVCS) of advanced cancer pts with poor Performance Status (PS) and/or comorbidity, unsuitable to first-line aggressive, multimodality treatments. Materials/Methods: From the period January 2000 to December 2001, forty-two pts (median age 69, range 59-83) suffering from malignant SVCS (neck and arm edema, jugular vein distension, dyspnea and orthopnea, cyanosis) were administered with double-flash LFRT within 24-48 hours of clinical presentation. Median ECOG-Zubrod PS was 2 (range 2-3). Histology was small-cell (10) and non-small-cell (21) lung cancer, breast (4), urotelial (3), colorectal (1) and unknown primary carcinoma (3). Seventeen lung cancer pts had been previously irradiated. A target dose of 12 Gy at isocenter was delivered in two 6-Gy fractions one week apart by means of 10 MV photons, opposed or multiple shaped fields. No air lung corrections were made. Pts were evaluated (chest x-rays and/or CT scans) just before the second fraction and again three weeks after the 12 Gy completion, in order to re-define target volumes and assess response. Further treatment with conventionally fractionated RT or combined chemoradiotherapy was planned for best fitted responders. Results: Partial relief of SVCS symptoms was experienced by 15 pts as early as 4-5 days after the first 6-Gy fraction. Evaluation of these pts before the second flash showed both partial or complete disappearance of SVCS clinical signs and reduction of the widened mediastinum causing target volumes to be re-defined. SVCS relief was complete in 32 pts (76%) and partial in 4 pts 3 weeks after the completion of 12 Gy, with an overall response rate of 86%. Chest x-rays and CT scans confirmed objective regression of the mediastinal mass (RECIST Criteria for Disease Response, J. Nat. Cancer Inst. 2000, 92) in 33 pts (78%), whereas they did not show any significant change in 3 pts despite SVCS partial recovery. Because of response and PS improvement 18 pts were scheduled to complete RT with standard fractionation up to 45 Gy and 10 pts could undergo concomitant chemoradiotherapy. According to the NCI Common Toxicity Scale, overall toxicity of LFRT was mild both in younger and older pts. Grade 1-2 nausea (8 pts), dysphagia from grade 1 esophagitis (9) and fatigue (14) were registered, yet they did not require any treatment. Nine pts (21%) experienced some systemic toxicity 12-24 hours after the first fraction, consisting of fever (not over grade 1), rigors and moderate chest pain. A 2-day mild anti-inflammatory drug therapy caused these symptoms to recover quickly. Conclusions: In our experience the 12-Gy/2-fraction/8-day RT schedule was an effective and safe tool in the “aggressive palliation” of SVCS in both younger and older pts unsuitable for more tailored, multimodality, first-line treatments. Psychological, social and economical advantages also emerged from such a resource-conscious approach particularly in the management of older pts, as opposed to conventionally fractionated RT." @default.
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• W2171085877 date "2002-10-01" @default.
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• W2171085877 title "Malignant superior vena cava syndrome can be effectively and safely managed with double-flash, large-fraction radiation therapy" @default.
• W2171085877 doi "https://doi.org/10.1016/s0360-3016(02)03594-0" @default.
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