The optimum radiation schedule in treatment of superior vena caval obstruction: Importance of 99mTc scintiangiograms

Abstract

The value of high daily dose (HDD) to relieve superior vena caval obstruction is assessed in 60 patients who were treated from 1965 to 1976. The essential features of this program include the immediate initiation of large fractional doses, usually 400 rad times 3, waiving a tissue diagnosis, and providing for rapid diuresis. The evidence indicates that rapid relief of symptoms occurs in 60% of patients in 1–2 days and in 86% within 3–4 days. Clearing of edema is slower, requiring 7 days for complete relief in 65% of patients. The importance of 99mTc serial angiograms is suggested as a sound prognosticator of response and prognosis. Improvement in obstruction usually occurs in those patients without collateralization, whereas the formation or presence of collaterals was a more ominous prognosticator and correlated with failure to improve symptoms.