Prophylactic cranial irradiation (PCI). Still a no-brainer?

Davey, Phillip; Ennis, Marguerite; Aviv, Richard I.

doi:10.1016/j.lungcan.2015.04.006

Cited by 6 publications

(2 citation statements)

References 30 publications

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“…NCCN guidelines recommend pre-PCI MRI for patients with response to initial therapy (28). Some prospective studies reported using MRI or CT scans, some did not require any imaging, and some did not mention any requirements for imaging (29,30). A recent survey conducted in the USA, demonstrated that up to 96% of 309 radiation oncologists performed pre-PCI MRI (31).…”

Section: Pre-pci Imaging For Limited Stage (Ls) or Es Sclcmentioning

confidence: 99%

Radiotherapy for brain metastases from small-cell lung cancer in distinct clinical indications and scenarios

Kępka¹,

Socha²,

Sas-Korczyńska³

2021

J Thorac Dis

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Small-cell lung cancer (SCLC) is a rapidly progressing disease with a predilection for early metastasizing. The most common site of metastases is the brain; about 40-50% of patients develop brain metastases (BM) within 2 years from diagnosis (1). Radiotherapy plays a crucial role in the management of BM from SCLC. However, there are a number of distinct biological and clinical characteristics of SCLC that preclude the direct incorporation of the results of the studies on the treatment of BM from other solid tumors to the management of BM from SCLC. These are: the high aggressiveness of the disease with rapid micro-and macro-dissemination to the brain, the rare occurrence without the presence of extracranial disease, chemo-sensitivity that incites the use of systemic treatment, the use of prophylactic cranial irradiation (PCI) as a part of the standard strategy for patients without BM, and a dismal disease course. The historical treatment of BM from SCLC was whole-brain radiotherapy (WBRT) alone or combined with chemotherapy (CHT). The outcome of such strategies was poor; median overall survival (OS) after WBRT was 3.0-4.7 months in both prospective and retrospective studies (2-5). However, a temporal trend towards a slight survival improvement in SCLC exists (6) and is also seen for patients with BM in recently published

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Section: Pre-pci Imaging For Limited Stage (Ls) or Es Sclcmentioning

confidence: 99%

Radiotherapy for brain metastases from small-cell lung cancer in distinct clinical indications and scenarios

Kępka¹,

Socha²,

Sas-Korczyńska³

2021

J Thorac Dis

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“…Brain imaging was not part of the initial staging in many trials and this has a direct impact on the reported incidence of brain metastases: in the absence of brain imaging PCI reduces the incidence of brain metastases from 53% to 40% and in case of a brain imaging from 33% to 10% (12). We should point out that in these studies brain imaging was done by CT or nuclear imaging.…”

Section: Impact Of Brain Imagingmentioning

confidence: 99%

Prophylactic cranial irradiation (PCI) or magnetic resonance imaging (MRI) monitoring in limited small cell lung cancer: is it a question?

Houtte¹,

Roelandts²,

Charlier³

et al. 2019

Precis Cancer Med

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Brain metastases are a major problem in the management of small cell lung cancer (SCLC) with an incidence rising to 50% at 2 years. Prophylactic cranial irradiation (PCI) has shown through randomized trials and meta-analysis to decrease the incidence of brain metastases by 25% leading to a 5% survival benefit at 3 years for patients in complete response to the initial therapy. The major concern with PCI is the risk of inducing neurologic symptoms, especially cognitive functions, and an impaired quality of life. In extensive disease SCLC, an active surveillance with magnetic resonance imaging (MRI) has questioned the value of routine PCI challenging its use for limited disease. In this paper, we will review some main limitations of the different randomized trials, the impact of new technologies and the data available on the possibility to omit (or not) PCI for limited disease.

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Should patients with laryngeal small cell neuroendocrine carcinoma receive prophylactic cranial irradiation?

Coca‐Pelaz

Devaney

Rodrigo

et al. 2015

Eur Arch Otorhinolaryngol

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While small cell neuroendocrine carcinomas (SCNCs) most often arise in the lung, extrapulmonary SCNCs arise in a variety of locations-including the head and neck region. In particular, laryngeal SCNCs-while rare tumors-are nevertheless recognized as distinct lesions. The rarity of laryngeal SCNC gives rise to two distinct difficulties: first (particularly with small biopsy specimens), laryngeal SCNC can be difficult to diagnose by routine light microscopy; second, limited experience with these tumors can make the crafting of a treatment plan for individual patients difficult. As regards the first problem, pathologic diagnosis is greatly enhanced by the application of immunohistochemistry. The second problem-crafting a successful treatment strategy-presents a much larger difficulty. It is tempting to extrapolate from experience with the (more common) pulmonary SCNC in search of a strategy applicable to laryngeal SCNC; such an extrapolation, however, may not be uniformly successful. In particular, while a combination of radiation therapy and chemotherapy appears to be as valuable in the treatment of extrapulmonary as it is in the treatment of pulmonary SCNC, prophylactic cranial irradiation (PCI)-which has enjoyed some success in the treatment of some patients with pulmonary SCNC-does not appear to have similar utility in patients with laryngeal SCNC. Accordingly, the use of PCI does not appear to have a role to play at this point in time in the treatment of patients with laryngeal SCNC.

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Prophylactic cranial irradiation (PCI). Still a no-brainer?

Cited by 6 publications

References 30 publications

Radiotherapy for brain metastases from small-cell lung cancer in distinct clinical indications and scenarios

Radiotherapy for brain metastases from small-cell lung cancer in distinct clinical indications and scenarios

Prophylactic cranial irradiation (PCI) or magnetic resonance imaging (MRI) monitoring in limited small cell lung cancer: is it a question?

Should patients with laryngeal small cell neuroendocrine carcinoma receive prophylactic cranial irradiation?

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