Role of Prophylactic Cranial Irradiation in Extensive-Stage Small Cell Lung Cancer

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Nathan Y. Yu Department of Radiation Oncology, and

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Terence T. Sio Department of Radiation Oncology, and

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Vinicius Ernani Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, Arizona.

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Panayiotis Savvides Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, Arizona.

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Steven E. Schild Department of Radiation Oncology, and

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Patients with small cell lung cancer (SCLC) are at significant risk of developing brain metastases during their disease course. Prophylactic cranial irradiation (PCI) has been incorporated into SCLC treatment guidelines to diminish the risk of developing brain metastases. In 2007, a randomized trial suggested that PCI decreases the incidence of brain metastases and prolongs overall survival (OS) in patients with extensive-stage SCLC (ES-SCLC) who have responded to initial therapy. However, this study did not include modern central nervous system imaging with CT or MRI prior to randomization. A more recent Japanese trial with MRI staging and surveillance demonstrated that PCI diminished the incidence of brain metastases but did not improve survival. This review examines the largest clinical studies, controversies, and future directions of PCI in patients with ES-SCLC.

Submitted July 20, 2021; final revision received October 5, 2021; accepted for publication October 21, 2021.

Disclosures: Dr. Schild has disclosed writing and editing for and receiving royalties from UpToDate. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Steven E. Schild, MD, Department of Radiation Oncology, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054. Email: sschild@mayo.edu
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