Diuretics are relatively contraindicated in patients with SVC syndrome because the attendant decrease in vascular volume lowers the pressure head of the SVC resulting in impaired drainage.
The use of steroids to reduce the inflammatory response to radiation therapy and, therefore, improve respiratory compromise, has not been based on scientific evidence. We do not recommend routine use of steroids prior to radiation.
Thrombosis as a cause of SVC syndrome, most commonly is a consequence of decreased blood flow secondary to malignancy or clot formation from an intravenous catheter. The use of anticoagulation therapy in the latter is not debated. Salsali, in his study of 10 patients with SVC syndrome secondary to malignancy, treated ten patients with adequate doses of fibrinolysin and radiation therapy. The effectiveness of therapy became evident 48 hours after treatment. These patients experienced prolonged survival, averaging 12.8 months, 4 months greater than patients treated with radiation therapy and chemotherapy, or radiation therapy alone.