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Prophylactic cranial irradiation in lung cancer
Pierre Blanchard1, Cécile Le Péchoux
1Radiation Oncology Department, Institut Gustave Roussy, Villejuif, France.
Current Opinion in Oncology
|December 2, 2009
Summary
Prophylactic cranial irradiation (PCI) reduces brain metastases in lung cancer patients, improving survival for small-cell lung cancer (SCLC) responders. While neurological toxicity is a concern, trials show no significant increase in late side effects with PCI.
Area of Science:
- Oncology
- Neurology
- Radiotherapy
Background:
- Brain metastases are a common and severe complication of lung cancer, significantly impacting patient quality of life and survival.
- Prophylactic cranial irradiation (PCI) is a strategy explored to prevent or reduce the incidence of brain metastases.
Purpose of the Study:
- To review the efficacy and safety of prophylactic cranial irradiation (PCI) in lung cancer patients.
- To determine the optimal use of PCI in small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC).
Main Methods:
- Review of randomized trials comparing PCI with no PCI in lung cancer.
- Analysis of data on the incidence of brain metastases, overall survival, and neurological toxicity.
Main Results:
- PCI significantly reduces brain metastasis incidence in SCLC (limited and extensive disease) and non-metastatic NSCLC.
- PCI improves overall survival in SCLC patients who respond to first-line treatment.
- No significant increase in long-term neurological sequelae was observed in randomized trials comparing PCI to no PCI.
Conclusions:
- PCI at 25 Gy in 10 fractions is recommended for responders with limited-disease SCLC.
- PCI is recommended for responders with extensive-disease SCLC.
- Ongoing trials are investigating PCI's role in NSCLC.
