Dr. Feldman on Prophylactic Cranial Irradiation in SCLC

Lawrence E. Feldman, MD, discusses utilizing prophylactic cranial irradiation in limited-stage and extensive-stage small cell lung cancer.

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.