Brain metastases in N2-positive non-small-cell lung cancer: implications for prophylactic cranial irradiation

Patients with non-small-cell lung cancer with positive lymph nodes (stage IIIA and IIIB) have an increased risk for brain metastases. Those with nonsquamous histology are at higher risk. Despite this fact, the use of prophylactic cranial irradiation (PCI) has not shown an improvement in survival in these patients and is still considered to be investigational. The Radiation Therapy Oncology Group attempted to prospectively address this in a randomized trial that recently closed because of poor accrual. We present 2 cases and review the literature and provide an argument for the consideration of PCI in select patients.