Chemotherapy can be used as the primary modality of treatment for SVC syndrome due to Hodgkin's disease, diffuse histiocytic lymphoma and small cell anaplastic lung carcinoma, which are known to be quite responsive to a combination of drugs. The rapid improvement of SVC syndrome secondary to small cell carcinoma of the lung is consistent with the growth kinetics and responsiveness of this tumor to combinations of active chemotherapeutic agents. Since all patients may not respond to chemotherapy alone, an alternative approach would be to begin combined modality treatment and terminate the radiation after only a modest dose of 1,000-2,000 rads.
The advantage to starting treatment with chemotherapy in cases of lymphoma, relates to decreasing the volume of lung that must be irradiated. If the tumor responds and shrinks in size, the subsequent portals of irradiation can be smaller, sparing more normal tissue.
When chemotherapy is to be administered, injection into arm veins, especially on the right side, should be avoided. Decreased blood flow can lead to slow drug distribution, and local irritation with resultant thrombosis.
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