The Case Against Prophylactic Cranial Irradiation in Limited Small Cell Lung Cancer

There have been significant advances in the treatment of small cell lung cancer during the past two decades. Systemic chemotherapy for extensive disease and combined modality therapy for limited small cell lung cancer has improved both quality and quantity of survival. In extensive disease, although the median survival time is improved with chemotherapy, only rarely is a patient cured. However, in limited disease, over 50% of the patients will achieve a complete remission and the 5-year survival is approximately 20%. There has been significant controversy concerning the role of prophylactic cranial irradiation, especially in patients with limited small cell lung cancer who achieve a complete remission. This article addresses the currently available data concerning benefit, toxicity, and results from randomized clinical trials using prophylactic cranial irradiation in patients with small cell lung cancer.