Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Oct;12(10):6225-6233.
doi: 10.21037/jtd.2020.03.80.

Prophylactic cranial irradiation or MRI surveillance for extensive stage small cell lung cancer

James M Taylor  1 , Chad G Rusthoven  2 , Drew Moghanaki  3
Affiliations
Review

Prophylactic cranial irradiation or MRI surveillance for extensive stage small cell lung cancer

James M Taylor et al. J Thorac Dis. 2020 Oct.

Abstract

The treatment paradigm for extensive stage small cell lung cancer (ES-SCLC) is evolving. Prophylactic cranial irradiation (PCI) has long been considered a component of standard treatment in patients with extensive stage disease who respond to chemotherapy. However, in the modern era of magnetic resonance imaging, the role of PCI has become an area of controversy following conflicting level I evidence. Due to conflicting data and toxicity concerns, the routine use of PCI has declined. Recent improvements in systemic disease control with the use of immunotherapy and reductions in the toxicity attributable to PCI with hippocampal avoidance and memantine have reignited the discussion. As such, we present here a narrative review of PCI with a focus on historical milestones, randomized data, risk mitigation and future directions.

Keywords: MRI surveillance; Small cell lung cancer (SCLC); extensive stage; prophylactic cranial irradiation (PCI).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd.2020.03.80). The series “Small Cell Lung Cancer” was commissioned by the editorial office without any funding or sponsorship. CGR reports that he is the national principle investigator of SWOG S1827/Maverick: MRI Brain Surveillance Alone versus MRI Surveillance and Prophylactic Cranial Irradiation (PCI): A Randomized Phase III Trial in Small-Cell Lung Cancer. The other authors have no other conflicts of interest to declare.

Similar articles

See all similar articles

Cited by

References

    1. Slotman B, Faivre-Finn C, Kramer G, et al. Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med 2007;357:664-72. 10.1056/NEJMoa071780 - DOI - PubMed
    1. Takahashi T, Yamanaka T, Seto T, et al. Prophylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer: a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol 2017;18:663-71. 10.1016/S1470-2045(17)30230-9 - DOI - PubMed
    1. Torre LA, Bray F, Siegel RL, et al. A. Global cancer statistics, 2012. CA Cancer J Clin 2015;65:87-108. 10.3322/caac.21262 - DOI - PubMed
    1. Wang S, Zimmermann S, Parikh K, et al. Current Diagnosis and Management of Small-Cell Lung Cancer. Mayo Clin Proc 2019;94:1599-622. 10.1016/j.mayocp.2019.01.034 - DOI - PubMed
    1. Haddadin S, Perry MC. History of small-cell lung cancer. Clin Lung Cancer 2011;12:87-93. 10.1016/j.cllc.2011.03.002 - DOI - PubMed