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Dr. Feldman on Prophylactic Cranial Irradiation in SCLC

Lawrence E. Feldman, MD
Published: Thursday, Nov 21, 2019



Lawrence E. Feldman, MD, professor of clinical medicine, University of Illinois Cancer Center, discusses the use of prophylactic cranial irradiation (PCI) in patients with limited-stage (LS) and extensive-stage (ES) small cell lung cancer (SCLC).
 
For decades, PCI was performed in LS-SCLC based on a meta-analysis that demonstrated improved overall survival (OS) and decreased occurrence of brain metastases, says Feldman. Conversely, in ES-SCLC, a randomized phase III trial (UMIN000001755) from Japan showed no OS benefit with PCI comparedwith observation. 
 
As such, patients with ES-SCLC are typically monitored closely with regular MRI scans every 3 months in the first year, and every 6 months in the second year. 
 
Although PCI is used more commonly in LS-SCLC, it may not be necessary in all patients. Rather, some patients could be observed and spared some of the neurocognitive toxicities associated with PCI, concludes Feldman.
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Lawrence E. Feldman, MD, professor of clinical medicine, University of Illinois Cancer Center, discusses the use of prophylactic cranial irradiation (PCI) in patients with limited-stage (LS) and extensive-stage (ES) small cell lung cancer (SCLC).
 
For decades, PCI was performed in LS-SCLC based on a meta-analysis that demonstrated improved overall survival (OS) and decreased occurrence of brain metastases, says Feldman. Conversely, in ES-SCLC, a randomized phase III trial (UMIN000001755) from Japan showed no OS benefit with PCI comparedwith observation. 
 
As such, patients with ES-SCLC are typically monitored closely with regular MRI scans every 3 months in the first year, and every 6 months in the second year. 
 
Although PCI is used more commonly in LS-SCLC, it may not be necessary in all patients. Rather, some patients could be observed and spared some of the neurocognitive toxicities associated with PCI, concludes Feldman.



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