Prophylactic Cranial Irradiation for Resectable Small-Cell Lung Cancer

After definitive chemoradiation for small-cell lung cancer (SCLC), prophylactic cranial irradiation (PCI) has been established as standard of care in patients whose tumors respond to treatment. In the modern era, however, a subset of patients might receive upfront resection for SCLC, yet the role of PCI in these patients has not been elucidated. In this review, we examine the literature to better define the role of PCI in this subset of patients. For patients with ≥ T2 disease, incomplete resection, or those not receiving adjuvant chemotherapy, PCI is expected to offer a clinical benefit. For patients with T1 tumors treated with R0 resection, however, the rate of intracranial metastasis might be < 10%. In these patients, deferral of PCI might be appropriate because it would avoid known neurocognitive sequelae of cranial irradiation.