title: Prophylactic cranial irradiation for patients with lung cancer.
abstract: The incidence of brain metastases in patients with lung cancer has increased as a result of improved local and systemic control and better diagnosis from advances in brain imaging. Because brain metastases are responsible for life-threatening symptoms and serious impairment of quality of life, resulting in shortened survival, prophylactic cranial irradiation has been proposed in both small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC) to try to improve incidence of brain metastasis, survival, and eventually quality of life. Findings from randomised controlled trials and a meta-analysis have shown that prophylactic cranial irradiation not only reduces the incidence of brain metastases in patients with SCLC and with non-metastatic NSCLC, but also improves overall survival in patients with SCLC who respond to first-line treatment. Although prophylactic cranial irradiation is potentially associated with neurocognitive decline, this risk needs to be balanced against the potential benefit in terms of brain metastases incidence and survival. Several strategies to reduce neurotoxicity are being investigated.
authors.affiliation: Department of Radiation Oncology, Gustave Roussy University Hospital, Villejuif, France. Electronic address: cecile.lepechoux@gustaveroussy.fr.
authors.forename: Cécile Le
authors.initials: CL
authors.lastname: Péchoux
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: Sun
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Slotman
authors.affiliation: Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Oncology, Experimental Radiation Oncology, KU Leuven, Leuven, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: De Ruysscher
authors.affiliation: Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
authors.forename: José
authors.initials: J
authors.lastname: Belderbos
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Gore
mesh_terms: D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D016371:Cranial Irradiation; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011788:Quality of Life