Prophylactic cranial irradiation in SCLC

Abstract

Rationale for prophylactic cranial irradiation in small cell lung cancer (SCLC)The concept of prophylactic cranial irradiation for patients with small cell lung cancer has been developed as a consequence of progress in combined modality treatment for thoracic disease: in spite of high responses to initial therapy in the thorax approximately 60% of the patients developed metastases in the brain (1). It was commonly assumed that blood-brain barrier was responsible for inability of chemotherapy to eliminate subclinical cancer in the brain. While the concept of blood-brain barrier has been recently modified by demonstrating the presence of functional lymphatic vessels in the dural sinuses (2), clearly, endothelial, epithelial and glial brain barriers establish compartments that differ with regard to their accessibility to the drugs. This established the biological rationales for prophylactic cranial irradiation: the direct cytotoxic effect of radiotherapy on subclinical brain metastases may be further enhanced by changes in blood-brain barrier permeability induced by radiotherapy (3). PCI in limited-stage SCLC Early trials on PCI in SCLCThe early trials on PCI in SCLC focused, primarily, on patients in complete remission after treatment for thoracic Review Article on Radiotherapy in Thoracic Malignancies

A New Nomogram and Risk Stratification of Brain Metastasis by Clinical and Inflammatory Parameters in Stage III Small Cell Lung Cancer Without Prophylactic Cranial Irradiation

“…The effect of PCI on the overall survival (OS) of patients with SCLC is still controversial. The randomized trial data showed that PCI reduced the rate of BM from about 60 to 30% and increased the 3-year OS by about 5% ( 8 ). Another multicenter and randomized trial result demonstrated that PCI reduced the rate of BM, but failed to improve the OS of the patient ( 9 ).…”

PAK3 downregulation induces cognitive impairment following cranial irradiation

“…1A). A total dose of 60 Gy in 30 fractions is typically delivered to the brain in patients with PCI (Suwinski, 2021; Wegner et al, 2019) , and previous studies reported that a total dose of 10 Gy caused impaired neurogenesis and cognitive behavior in mice (Pazzaglia et al, 2020; Raber et al, 2004) . In this regard, mice were irradiated with five fractions of 2 Gy administered to the cranial region (Ceyzériat et al, 2021; Wilson et al, 2020) .…”

Health Economic Evaluation of Proton Therapy for Lung Cancer: A Systematic Review

“…In addition to the CEA published in 2010 [ 30 ], which was summarized by the most recent systematic review in general (not specific for lung cancer) [ 16 ], we further summarized other broader [ 28 , 29 ] or more recent [ 31 ] HEEs. We found that the available HEEs regarding proton therapy for lung cancer were limited to specific scenarios of lung cancer radiotherapy, whereas no HEE was available for the vast majority of common radiotherapy indications for lung cancer ( Table 2 ) [ 2 , 32 ]. Our study was, to our knowledge, the first systematic review specifically for HEE of lung cancer proton therapy.…”