TY - JOUR
T1 - Prophylactic cranial irradiation (PCI), hippocampal avoidance (HA) whole brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS) in small cell lung cancer (SCLC)
T2 - Where do we stand?
AU - Crockett, Cathryn
AU - Belderbos, José
AU - Levy, Antonin
AU - McDonald, Fiona
AU - Le Péchoux, Cecile
AU - Faivre-Finn, Corinne
N1 - Funding Information:
Dr Fiona McDonald acknowledges NHS funding to the NIHR Biomedical Research Centre and the Clinical Research Facility at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust . Prof. Corinne Faivre-Finn was supported by NIHR Manchester Biomedical Research Centre .
Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Small cell lung cancer (SCLC) is an aggressive form of lung cancer associated with an increased risk of develping brain metastases (BM), which are a significant cause of morbidity and mortality. Prophylactic cranial irradiation (PCI) was first introduced in the 1970s with the aim of reducing BM incidence and improving survival and quality of life (QoL). Prospective clinical trials and meta-analyses have demonstrated its effectiveness in reducing BM incidence and improving survival, across all stages of the disease following response to induction chemotherapy. Despite its long history, "unknowns" surrounding PCI use still exist and there are particular subgroups of patients for which its use remains controversial. PCI is known to cause neurocognitive toxicity which can have a significant impact on a patient's QoL. Strategies to minimise this, including the use of hippocampal avoidance radiotherapy techniques, neuroprotective drugs and stereotactic radiosurgery in place of whole brain radiotherapy for the treatment of BM, are under evaluation. This review offers a summary of the key PCI trials published to date and the current treatment recommendations based on available evidence. It also discusses the key questions being addressed in ongoing clinical trials and highlights others where there is currently a knowledge gap and therefore where further data are urgently required.
AB - Small cell lung cancer (SCLC) is an aggressive form of lung cancer associated with an increased risk of develping brain metastases (BM), which are a significant cause of morbidity and mortality. Prophylactic cranial irradiation (PCI) was first introduced in the 1970s with the aim of reducing BM incidence and improving survival and quality of life (QoL). Prospective clinical trials and meta-analyses have demonstrated its effectiveness in reducing BM incidence and improving survival, across all stages of the disease following response to induction chemotherapy. Despite its long history, "unknowns" surrounding PCI use still exist and there are particular subgroups of patients for which its use remains controversial. PCI is known to cause neurocognitive toxicity which can have a significant impact on a patient's QoL. Strategies to minimise this, including the use of hippocampal avoidance radiotherapy techniques, neuroprotective drugs and stereotactic radiosurgery in place of whole brain radiotherapy for the treatment of BM, are under evaluation. This review offers a summary of the key PCI trials published to date and the current treatment recommendations based on available evidence. It also discusses the key questions being addressed in ongoing clinical trials and highlights others where there is currently a knowledge gap and therefore where further data are urgently required.
KW - Brain Neoplasms/radiotherapy
KW - Cranial Irradiation/adverse effects
KW - Hippocampus
KW - Humans
KW - Lung Neoplasms/radiotherapy
KW - Prospective Studies
KW - Quality of Life
KW - Radiosurgery/adverse effects
KW - Small Cell Lung Carcinoma/radiotherapy
U2 - 10.1016/j.lungcan.2021.10.016
DO - 10.1016/j.lungcan.2021.10.016
M3 - Article
C2 - 34768007
SN - 0169-5002
VL - 162
SP - 96
EP - 105
JO - Lung cancer (Amsterdam, Netherlands)
JF - Lung cancer (Amsterdam, Netherlands)
ER -
