How do you treat non-small cell lung cancer presenting with SVC syndrome?

It depends on a number of things. I would say if the patient presents with metastatic disease, I would still favor a 5-10 fraction (20-30 Gy total) approach to palliate, and maybe consider a stent if IR feels it is possible.

Alternatively, if this is locally advanced, then I would attempt definitive chemoradiation followed by maintenance therapy based on molecular testing.

If limited metastatic disease, I have proceeded with hypofractionated radiation therapy alone while molecular testing is pen...

If it is newly diagnosed, I always make sure that they have completed a staging workup with brain MRI and CT C/A/P with good contrast, as PET is difficult to obtain as an inpatient.

The emergent treatment of SVC syndrome depends on the severity of symptoms and whether it is acute. Many times, if it is chronic, they are already compensated with the development of collaterals. If the patient is symptomatic, I recommend an IR consult for a stent placement evaluation, as it can give immediate sympto...

The following text is copied from the chapter on SVC syndrome in the 3rd edition of the "Essentials of Clinical Radiation Oncology" textbook, of which I am the senior editor. It provides a brief summary of the general approach to consider when addressing this syndrome. Please refer to the textbook if interested in the fully detailed chapter:

"SVC syndrome is an urgent clinical scenario but not an emergency unless presenting with clinically severe airway, neurologic, or hemodynamic compromise. Tr...