Is prophylactic cranial irradiation (PCI) needed in patients with extensive-stage small cell lung cancer showing complete response to first-line chemotherapy?

Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology
Kaname NosakiNobuyuki Yamamoto

Abstract

Throughout the entire world, prophylactic cranial irradiation (PCI) is the standard care for patients with small cell lung cancer (SCLC) in whom a favorable therapeutic effect is achieved after front-line treatment, regardless of whether the disease is in the limited stage or extensive stage. In the EORTC study, PCI was shown to confer a survival benefit for patients with extensive-stage small cell lung cancer (ES-SCLC) who experienced any positive response after initial chemotherapy. However, the Japan study failed to confirm a survival benefit. As a result, the guidelines in Japan recommend that PCI should not be carried out in cases of ES-SCLC. Complete response (CR) subset analysis in the Japan study suggested that PCI did not provide a survival benefit for patients with ES-SCLC. PCI with a risk of adverse events has poor significance, even if the patients show CR to chemotherapy.

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