Prophylactic cranial irradiation in lung cancer

Purpose of review Brain metastases are frequent in lung cancer. They are responsible for life-threatening symptoms and serious impairment in patients' quality of life, resulting in a shortened survival. Prophylactic cranial irradiation (PCI) has been proposed in both small-cell lung cancers (SCLCs) and non-SCLCs to reduce the incidence of brain metastases and increase survival. Recent findings PCI reduces the incidence of brain metastasis in both limited disease and extensive disease SCLC and in nonmetastatic non-SCLC. In addition, PCI significantly improves overall survival in limited disease and extensive disease SCLC in patients who respond to first-line treatment. Although PCI is potentially associated with long-term neurological toxicity, no significant increase in late sequelae has been shown in randomized trials between PCI and no PCI patients. No dose-effect relationship for PCI was demonstrated in limited disease SCLC patients in a well powered randomized trial. Summary In limited disease SCLCs, PCI should be administered at the dose of 25 Gy in 10 fractions to first-line treatment responders. In extensive disease SCLC, PCI is recommended in patients who respond to first-line chemotherapy. Clinical trials are ongoing to investigate the role of PCI in non-SCLC patients.