Prophylactic Cranial Irradiation (PCI)

Author: Courtney Misher, MPH, BS R.T.(T)
Last Reviewed: December 02, 2022

Prophylactic cranial irradiation (PCI) is used to prevent cancer from spreading (metastasizing) to your brain from primary tumors in other areas of your body that often spread to the brain. Prophylactic means preventive, and cranial means head.

When is PCI given?

Cancer cells in the brain can be hard to treat because only some chemotherapy medications can pass through the blood-brain barrier. The blood-brain barrier is made up of tissues and vessels that filter what can get into the brain. To prevent cancer cells from growing in the brain PCI can be given. PCI is sometimes used as part of the treatment for:

  • Small cell lung cancer (SCLC).
  • Acute lymphoblastic leukemia (ALL).
  • Lymphoblastic lymphoma.

How is PCI given?

PCI is planned and treated like traditional radiation therapy, but the amount of radiation given with PCI is much less than the amount given for primary brain cancers (tumors that started in the brain). The dose will likely be between 12-18 Gy. Radiation will be given once or twice a day. If you are getting two treatments a day you will have a 6–8-hour break between treatments.

What are the side effects of PCI?

The following are some of the most common acute (short-term) side effects of PCI. Treatment can affect each patient differently, and you may not have any of these side effects. Side effects of PCI are usually mild, but can include:

  • Fatigue is very common with radiation. Fatigue typically goes away slowly over the weeks and months following treatment.
  • Headache is a painful feeling in any part of your head that can vary in intensity (mild to severe) and in how it feels (throbbing, sharp, or dull).
  • Hair loss may happen on your head where you received radiation. Hair typically starts to regrow a few months after treatment. However, your hair might not grow back exactly as it was before treatment and for some, the hair loss becomes permanent.
  • Nausea and Vomiting is a “sick” or “queasy” feeling in your stomach. Vomiting or “throwing up” often goes along with nausea.
  • Skin irritation: The skin on your head may become red, irritated, dry, or sensitive. Treat the skin gently to avoid further irritation Wear a hat to avoid sun exposure. Sun can worsen the irritation.
  • Loss of appetite is when you do not feel hungry or have no interest in eating. It is important to keep yourself well-nourished and to stay hydrated.

Chronic (long-term) effects may include:

  • Neurocognitive impairment (changes in how your brain works) like memory loss, confusion, and trouble concentrating.
  • Changes in your vision.
  • Trouble moving around and unsteadiness.
  • Trouble doing everyday tasks.

If you start to have any new or worsening side effects, you should talk to your care team.

Is PCI right for me?

Talk with your provider about your diagnosis and whether PCI should be part of your treatment plan. Your provider can explain the benefits and risks of preventative treatment. Together with your provider, you can decide if PCI is the best choice for your long-term cancer care.

Matutino, A., Mak, M. P., Takahashi, T. K., Bitton, R. C., Nakazato, D., Fraile, N. M. P., Guimarães, R. G. R., Gabrielli, F. C. G., Vasconcelos, K. G. M. C., Carvalho, H. A., & de Castro, G., Jr (2018). Prophylactic Cranial Irradiation for Extensive-Stage Small-Cell Lung Cancer: A Retrospective Analysis. Journal of global oncology, 4, 1–7.

Witlox, W. J., Ramaekers, B. L., Zindler, J. D., Eekers, D. B., Van Loon, J. G., Hendriks, L. E., ... & De Ruysscher, D. K. (2018). The prevention of brain metastases in non-small cell lung cancer by prophylactic cranial irradiation. Frontiers in oncology, 8, 241.

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