When do you recommend RT versus stenting for SVC syndrome in patients who cannot receive systemic therapy?

The option to stent upfront should always be considered before starting palliative treatment for SVC syndrome. Especially since it can offer reliable relief in a more timely manner. More importantly, it can at times avoid premature death in those in whom XRT might not work.

However, it's critical to sit down with an interventional radiologist who you trust and review the case in full detail. Stenting an SVC that is collapsed by any length of tumor carries a high risk of dissection and can lead to immediate and serious complications. Pay close attention to the coronal CT images to see what degree and length of vein is collapsed as this helps us assess the risk:benefit ratio of stenting. In my experience, this more often than not leads to a r...

I agree with @Dr. First Last. I've always tried to get stents put in for those patients if IR thinks it's feasible to do so safely. Otherwise, proceed with rads.