SHOULD CURRENT MANAGEMENT OF SMALL-CELL LUNG-CANCER INCLUDE PROPHYLACTIC CRANIAL IRRADIATION

The literature on the use of prophylactic cranial irradiation (PCI) in the management of small cell lung cancer (SCLC) is reviewed, focusing on the ten randomized trials published until 1991. Eight out of ten r andomized trials have shown some reduction in the frequency of CNS rel apse in patients who have had PCI, whereas none have shown any surviva l benefit associated with PCI. Current data indicate that survival is exclusively dependent on an effect of PCI in only a very limited subgr oup of patients (10% of complete responders). It is generally agreed t hat PCI is not justified in patients who are not in CR, but even in th is situation it is unknown whether PCI is necessary. The current thera peutic potentials seem to leave comparable fractions of patients witho ut sufficient palliation of their symptomatic brain metastases regardl ess of whether or not PCI is given. Data from sufficiently large rando mized trials have to be matured and analyzed, before the role of PCI i n SCLC can be defined.