Cranial irradiation, prophylactic

Radiotherapy is utilized to prevent and treat brain metastases, a frequent occurrence with SCLC. Prophylactic cranial irradiation is used in selected patients to reduce the risk of brain metastases. Neurologic and intellectual impairment are associated with prophylactic cranial irradiation, although other factors may also contribute. 

Kotalik J, Yu E, Markman BR, et al. Practice guideline on prophylactic cranial irradiation in small-cell lung cancer. Int J Radial Oncol Biol Phys 2001 50(2) 309-316. 

Auperin A, Arriagada R, Pignon JP, et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med 1999 341(7) 476-J84. 

Table 5 Summary of Prophylactic Cranial Irradiation for SCLC Patients ...

Gregor A, Cull A, Stephens RJ, et al. Prophylactic cranial irradiation as indicated following complete response to induction therapy in small-cell lung cancer Results of a multicentre randomized trial. Eur J Cancer 1997 33(Suppl 1) 1752-1758. 

Because SCLC has the propensity to disseminate early on in the disease, surgery is not usually indicated. SCLC is radiosensitive, and radiotherapy is used in combination with chemotherapy in patients with limited disease. Prophylactic cranial irradiation is used in select patients to reduce the risk of CNS metastases. Combination chemotherapy will prolong the survival of most patients with SCLC. Patients with limited disease are more likely to have a complete response to chemotherapy and longer survival than those who have extensive disease at the time of diagnosis. The most widely used chemotherapy regimens for SCLC include cisplatin or carboplatin plus etoposide. Despite very high response rates to chemotherapy, most patients with SCLC eventually have disease progression and die from this disease. 

Catane R, Schwade JG, Yarr I, et al Follow-up neurological evaluation in patients with small cell lung carcinoma treated with prophylactic cranial irradiation and chemotherapy. Int J Radiat Oncol Biol Phys 7 105-109, 1981 Cetingul N, Aydinok Y, Kantar M, et al Neuropsychologic sequelae in the long-term survivors of childhood acute lymphoblastic leukemia. Pediatr Hematol Oncol 16 213-220, 1999... 

Freeman JE, Johnston PGB, Voke JM Somnolence after prophylactic cranial irradiation in children with acute lymphoblastic leukaemia. BMJ 4 523-525, 1973 Fuss M, Poljanc K, Hug EB Full-scale IQ (FSIQ) changes in children treated with whole brain and partial brain irradiation a review and analysis. Strahlenther Onkol 176 573-581, 2000... 

Because the high risk of central nervous system relapse in ALL, all patients require prophylactic therapy to prevent CNS disease. The choice for therapy includes a combination of the following cranial irradiation and single-agent intrathecal chemotherapy, triple-drug intrathecal chemotherapy, or high-dose systemic chemotherapy that crosses the blood-brain barrier. 

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