Prophylactic cranial irradiation (PCI). Still a no-brainer?

Although prophylactic cranial irradiation (PCI) has been the standard of practice for patients successfully treated for limited stage small cell lung cancer for decades, subsequent changes in patient selection, updated brain imaging guidelines, an increased understanding of the mechanisms underlying the deleterious effects of whole brain irradiation as well as ongoing investigations into improving radiation treatment delivery have begun to question the current role of PCI. Who should be treated and how? This review attempts to gather together evidence for improving patient selection and describe potential improvements in treatment delivery.