Prophylactic cranial irradiation for patients with small cell lung cancer
- Elizabeth H Baldini, MD, MPH
Elizabeth H Baldini, MD, MPH
- Associate Professor of Radiation Oncology
- Harvard Medical School
- Section Editors
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine Emeritus
- National Jewish Health
- Steven E Schild, MD
Steven E Schild, MD
- Section Editor — Radiation Therapy
- Professor of Radiation Oncology
- Mayo Clinic College of Medicine
The natural history of small cell lung cancer (SCLC) is one of rapid tumor growth and early dissemination. Because of this, the therapeutic approach is different from that used for patients with non-small cell lung cancer (NSCLC).
Although the tumor, node, metastasis (TNM) staging system is recommended (table 1), patients with SCLC are typically divided into those with limited stage versus extensive stage disease. Limited stage disease is defined as disease confined to one hemithorax (ie, disease which can be included in a "tolerable" radiation field). About one-third of patients present with limited disease, although many of these patients probably already have subclinical metastatic disease.
Chemotherapy is an integral component of the treatment of patients with limited stage SCLC because of the high likelihood of early dissemination, including the minority of patients without mediastinal involvement who may be candidates for initial surgical resection. In addition, radiation therapy (RT) is important because local tumor progression occurs in up to 80 percent of patients with limited stage disease treated with chemotherapy alone . (See "Limited stage small cell lung cancer: Initial management".)
Brain metastases are a frequent problem in patients with SCLC, and brain imaging (preferably MRI) is indicated for patients who present with either limited or extensive stage disease . (See "Pathobiology and staging of small cell carcinoma of the lung", section on 'Staging'.)
Prophylactic cranial irradiation (PCI) for patients without detectable brain metastases can decrease the frequency of subsequent intracranial relapse and improve survival for patients with SCLC. The role of PCI in the treatment of both limited stage and extensive stage SCLC will be reviewed here.
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