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Prophylactic Cranial Irradiation for Resectable Small-Cell Lung Cancer
Aditya Halthore1, Anuj Goenka1, Rajiv Sharma1
1Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, Lake Success, NY.
Clinical Lung Cancer
|September 30, 2017
Summary
Prophylactic cranial irradiation (PCI) may benefit small-cell lung cancer (SCLC) patients with advanced disease or incomplete resection. For early-stage T1 SCLC with complete resection, PCI may be deferred to avoid neurocognitive side effects.
Area of Science:
- Oncology
- Radiation Oncology
- Thoracic Surgery
Background:
- Prophylactic cranial irradiation (PCI) is standard after chemoradiation for responsive small-cell lung cancer (SCLC).
- The role of PCI in SCLC patients undergoing upfront resection is not well-defined.
Purpose of the Study:
- To review the literature and clarify the role of PCI in SCLC patients treated with initial surgery.
Main Methods:
- Literature review of studies investigating PCI in surgically treated SCLC patients.
Main Results:
- PCI likely benefits patients with T2 or greater disease, incomplete resection, or those not receiving adjuvant chemotherapy.
- For T1 SCLC with R0 resection, intracranial metastasis rates may be below 10%, suggesting PCI deferral is a viable option.
- Deferring PCI in select early-stage patients can prevent neurocognitive sequelae.
Conclusions:
- PCI decision-making in surgically treated SCLC should be individualized based on tumor stage, resection completeness, and adjuvant treatment.
- Deferring PCI in early-stage, completely resected SCLC may be appropriate to mitigate treatment toxicity.
