Prophylactic cranial irradiation (PCI) for patients with small cell lung cancer (SCLC)

Abstract

Objectives: Profilactic whole brain (or cranial) irradiation (PCI) reduce incidence of brain metastasis and benefits patients with SCLC. Materials and methods: Based on literature review. Results: Approximately 10% of patients with SCLC present with brain metastases at initial diagnosis, and an additional 40% to 50% will develop brain metastases during the course of disease. Early trials comparing PCI vs follow-up showed reduced brain metastases, but inconclusive effects on overall survival (OS). Aupérin and colleagues conducted a meta-analysis of 7 randomized trials comparing PCI vs follow-up for patients in complete response, after initial treatment. PCI reduced the incidence of brain metastases in 2 years from 58.6% to 33.3% and improved 3-year OS from 15.3% to 20.7%. Meert and colleagues confirmed an OS benefit for those with a complete response. No dose-effect relationship for PCI was showed in LD SCLC patients so that the recommended dose is 25 Gy in 10 fractions. It is recomended after curative chemoradiotherapy, if complete response is achived. Conclusion: PCI is recomended to patients with complete response to treatment, excluding patients with preexisting contraindications or patient at high risk for neurocognitive deterioration. Modern radiotherapy techniques contribute reducing the risk of side effects from PCI