Urgent radiotherapy for superior vena cava syndrome in metastatic non-small cell lung cancer: a case report

Superior vena cava (SVC) syndrome is a life-threatening complication of thoracic malignancies, requiring rapid management in the setting of airway compromise or hemodynamic instability. We present a 59-year-old male with metastatic non-small cell lung cancer (NSCLC) who developed superior vena cava syndrome (SVCS) due to compression from a large mediastinal mass identified as metastatic lung adenocarcinoma. His declining respiratory status progressed rapidly, necessitating intensive care. After extensive multidisciplinary collaboration, the patient was determined fit for inpatient radiation therapy and 10 fractions of 300 cGy external beam radiotherapy to the obstructing lesion was planned. However, the patient was unable to lay supine for radiation treatment due to dyspnea, so he was transferred to an academic center, where custom immobilization setup was available to accommodate the patient's inability to tolerate a standardized supine position utilized by most outpatient radiation centers. The patient's symptoms and oxygen requirement then improved markedly, enabling transition to outpatient care for the remaining two radiotherapy (RT) fractions and chemotherapy. This case highlights the value of hypofractionated radiotherapy and institutional adaptability in managing acute oncologic emergencies such as SVC syndrome.