The treatment of malignant superior vena caval obstruction is a radiotherapeutic emergency. In 11 patientswtih superior vena caval obstruction there is an excellent response to the use of the initial high-dose course ofirraditional consisting of 400 rads midplane for 3 days, then reduced to conventional daily fractionation.(150-200 rads/day). We conclude that rapid high-dose irradiation in the management of SVC is more safe andeffective.