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Prophylactic cranial irradiation in small-cell lung cancer: update on patient selection, efficacy and outcomes

Authors Manapov F, Käsmann L, Roengvoraphoj O, Dantes M, Schmidt-Hegemann NS, Belka C, Eze C

Received 3 April 2018

Accepted for publication 29 May 2018

Published 16 August 2018 Volume 2018:9 Pages 49—55


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Sai-Hong Ignatius Ou

Farkhad Manapov,1,2 Lukas Käsmann,1 Olarn Roengvoraphoj,1 Maurice Dantes,1 Nina-Sophie Schmidt-Hegemann,1 Claus Belka,1,2 Chukwuka Eze1

1Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; 2Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany

Abstract: Over 10% of small-cell lung cancer (SCLC) patients have brain metastases (BM) at initial diagnosis; more than 50% will develop BM within 2 years. BM are detected in up to 80% of all patients at autopsy. After primary treatment, prophylactic cranial irradiation (PCI) has been established as standard of care in SCLC patients responding to initial therapy. Based on level I evidence, PCI significantly decreases the risk of intracranial relapse and shows a modest survival benefit after 3 years. However, the role of PCI in defined patient subgroups such as resected SCLC, elderly and extensive stage patients with access to magnetic resonance imaging surveillance and stereotactic radiotherapy is yet to be fully clarified. Furthermore, strategies to effective prevention of neurocognitive decline after PCI remain unclear. All these factors significantly impact treatment decision making and should be evaluated in prospective settings. New concepts such as hippocampal avoidance and drug neuroprotection prevent chronic neurocognitive effects reducing treatment-related side effects of PCI. The aim of this review is to present a summary and update of the latest evidence for patient selection, efficacy and outcome of PCI.

Keywords: PCI, small-cell lung cancer, treatment, patient selection, neurocognition

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