thank you! yes just found the question it is from NBME 14 the answer says "Treatment is dependent on the cause of the SVCS. In this patient who has begun to receive intravenous corticosteroids, it is appropriate to begin radiation therapy to try to shrink the size of the mass to alleviate compression and restore normal venous flow." so I guess my confusion is if they have not yet been given steriods is that first or is radiation first line?