PCI in CR Patients With SCLC

Abstract

Patients with limited-disease small cell lung cancer (LD-SCLC) are treated with cisplatin-containingchemotherapy combined with radiotherapy and the 5-year survival is expected to be 20-25%. As the outcome of treatmentand local control have been improved, brain metastasis has become a major site of first failure and prophylacticcranial irradiation (PCI) has been investigated to prevent brain metastasis. The conditions for PCI to be clinically usefulare that brain metastasis is the only site of recurrence in most patients, that PCI is effective to eradicate microscopicmetastasis, that the toxicity of PCI is not severe, and that PCI prolongs the survival. The metaanalysis of PCI trials reportedin 1999 concluded that PCI should be considered for patients who obtain complete response (CR) after first-linetreatment. However, issues such as the diagnostic modality used in response evaluation, optimal dose and timing, andprecise evaluation of late toxicity remain unsolved. Here these issues are reviewed and future directions are indicated.