Treatment of Superior Vena Cava Syndrome-Reply

In Reply.— Drs Rosenbloom and Rosenfelt question our contention that chemotherapy might replace radiation therapy as standard treatment for SVC syndrome in patients with non-small-cell lung cancer. They claim a radiation therapy response rate of 80% to 90% and wonder whether chemotherapy can do as well. Unfortunately, the studies that they cite include patients with both small-cell and non-small-cell carcinoma with no breakdown of response rates by tumor histology. 1 In treating SVC syndrome or any other manifestations of tumor growth, the most active cytotoxic therapy should be used. In small-cell lung cancer, for example, radiation therapy was the mainstay of therapy for SVC obstruction until effective combination chemotherapy regimens were discovered. Thereafter, in many institutions, chemotherapy has replaced radiation therapy as the treatment of choice. 2,3 Similar reasoning should be used in the management of SVC syndrome in non-small-cell lung cancer. We were encouraged to test chemotherapy in such