Dr. Feldman on Prophylactic Cranial Irradiation in SCLC

Lawrence E. Feldman, MD, professor of clinical medicine, University of Illinois Cancer Center, discusses the use of prophylactic cranial irradiation (PCI) in patients with limited-stage (LS) and extensive-stage (ES) small cell lung cancer (SCLC).

For decades, PCI was performed in LS-SCLC based on a meta-analysis that demonstrated improved overall survival (OS) and decreased occurrence of brain metastases, says Feldman. Conversely, in ES-SCLC, a randomized phase III trial (UMIN000001755) from Japan showed no OS benefit with PCI comparedwith observation.

As such, patients with ES-SCLC are typically monitored closely with regular MRI scans every 3 months in the first year, and every 6 months in the second year.

Although PCI is used more commonly in LS-SCLC, it may not be necessary in all patients. Rather, some patients could be observed and spared some of the neurocognitive toxicities associated with PCI, concludes Feldman.