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It is still controversial whether upfront systemic therapy without radiotherapy is safe for SVC syndrome in non-small cell lung cancer (NSCLC) patients. In addition, the benefit of steroids and diuretics is questionable until now. Therefore, relations between the treatments and survival need to be investigated.

Data of patients with SVC syndrome due to metastatic NSCLC, including age, sex, performance status, smoking status, histology, locations of distant metastases, previous treatments, SVC thrombosis, SVC syndrome grade, upfront treatment (radiotherapy versus systemic therapy), steroids, diuretics, intubation and anticoagulants as independent factors, were retrospectively collected. Associations between these variables and time to death were analyzed using the Cox proportional hazard regression.

From January 2012 to August 2022, 80 patients who fitted study criteria were identified. The mean age was 60.2 year (SD 10.4). 85% were male and 67.5% had a history of smoking. Most patients had adenocarcinoma (49%). Visceral and bone metastases were found in 65% and 21.3%, respectively. Systemic treatment for metastatic disease was given in 28.7% of the patients prior to diagnosis of SVC syndrome. 20% had SVC thrombosis. There were 18 patients (22.5%) receiving systemic therapy as an upfront treatment for SVC syndrome. Steroids, diuretics, and anticoagulants were administered in 47.5%, 38.8% and 13.8%, consecutively. No significant independent factor was found in both univariable and multivariable analysis. Patients receiving upfront systemic treatment and radiotherapy had median overall survival (OS) of 34 and 57 days, respectively, while 1-year OS were 11.8% and 8.8%, consecutively. Both patients with and without steroids had a median OS of 35 days. 1-year OS were 5.6% and 13.2%, respectively. Median OS of ones who were administered with diuretics was 30 days, whereas 35 days was median OS of ones without diuretics. 1-year OS were 7.7% and 10.4%, consecutively.

Systemic treatment is safe as an upfront therapy for advanced stage NSCLC patients presenting with SVC syndrome. There is no benefit of steroids or diuretics in terms of survival in these patients.