Superior vena cava obstruction [SVCO] in patients with advanced non small cell lung cancer [NSCLC]

ABSTRACT

To report on prognostic and treatment factors influencing the response of SVCO and related survival outcomes in advanced non small cell lung cancer. From November 2008 through December 2011, 18 consecutively diagnosed NSCLC patients with SVCO were included in this study. The patient, tumor and treatment related factors were analyzed. Median overall survival [OS], Kaplan -Meier survival plots, T-test, Cox Proportional Hazards models were generated by multiple covariates [MVA] and analyzed on SPSS software [version 19.0; SPSS, Inc., Chicago, IL]. Thirteen patients [72%] had presented with SVCO before the pathological diagnosis of underlying lung malignancy, while 5 [28%] progressed to SVCO after initiating treatment with chemotherapy. Twelve [68%] patients achieved subjective relief from the obstruction at the completion of palliative radiation therapy. Treating oncologists preferred 4 Gy per fraction in 11 [62%], while the median biologically equivalent dose delivered was 28 Gy. Six [33%] patients received chemotherapy during the course of treatment. Median OS of the entire cohort was 3 +/- 1.85mths and 1-year survival rate of 7%. Univariate analysis confirmed that SVCO patients with good performance score [p=0.02], and partial response to chemotherapy [p= 0.001] have superior OS. However, Cox regression modeling for MVA demonstrated only good performance SVCO patients [p = 0.05] have a better OS. RT effectively relieves SVCO but overall poor survival associated in our clinical scenario needs to be improved with multimodality approach. Adjuvant chemotherapy is to be considered after initial radiation therapy in good performance patients