Ask the Experts Archive > Types of Cancer > Lung Cancers > Small-Cell Lung Cancer

Prophylactic Cranial Radiation for Small Cell Lung Cancer

Affiliation: Abramson Cancer Center of the University of Pennsylvania
Last Modified: September 24, 2006

Dear OncoLink "Ask The Experts,"

Can you give me information and statistics on prophylactic cranial irradiation for prevention of small cell lung cancer? My husband is in remission and this procedure has been recommended. Thank you.

Barbara Campling, MD, Medical Oncologist at the Abramson Cancer Center of the University of Pennsylvania, and Stephen M. Hahn, MD, Associate Professor of Radiation Oncology and the Division of Hematology/Oncology at the Hospital of the University of Pennsylvania, respond:

It's good to hear that your husband is in remission from his small cell lung cancer. As you probably know, small cell lung cancer has a tendency to spread outside the chest, and one of the most unpleasant sites of metastasis is the brain. In patients who have gone into remission with treatment, the chances of eventual recurrence in the brain are quite high?about 60% at two years. This is probably because the chemotherapy drugs that are used to treat small cell lung cancer do not penetrate brain tissue very well. The chance of recurrence in the brain can be reduced to about 10% by giving radiation to the brain. This is called prophylactic cranial irradiation (PCI). Prophylactic means preventive or protective, and cranial irradiation refers to treatment of the whole brain with the use of high-energy x-rays in order to destroy any potential microscopic cancer in this area.

Many individual studies have shown that this prophylactic treatment reduces the chance of brain recurrence. When all the studies are examined together, it appears that there is also some improvement in overall survival in patients who get PCI compared to those who do not. The downside of this treatment is that it can delay recovery from the treatment that has already been given. There may also be some slight chance of cognitive impairment as a result of the therapy. This is not well understood because there have not been any large, long-term studies of the side effects. PCI is generally recommended for patients who have had a remission with therapy. You and your husband should discuss this in detail with his Radiation Oncologist.