Ask the Experts: “I have small cell lung cancer and my doctor mentioned the option of having prophylactic cranial irradiation (PCI) to help prevent the cancer from spreading to my brain. I know some people decide to have PCI and others do not. What information do I need to make the best decision for me?”

Making the decision whether to have prophylactic cranial irradiation (PCI) can be difficult and there is a lot to think about. Knowing as much as you can about PCI and your other options can help you weigh the risks and benefits and lead you to the best choice.

About PCI

When lung cancer spreads to the brain it is called “brain metastasis” or “brain mets.” PCI is a type of brain radiation that is sometimes used to prevent brain mets by treating all or most of the brain with lower doses of radiation.

Studies have shown that while PCI decreases the risk of brain mets in small cell lung cancer (SCLC), it is unclear whether it helps increase survival. It can also cause changes in memory and other thinking skills. More studies are being done to compare the overall outcomes of those who chose to have PCI and those who did not.

There are methods that can decrease the risk of changes in memory and thinking skills from PCI. Sometimes the memory area of the brain, called the hippocampus, can be “spared” (won’t get the radiation). There are also medicines that can sometimes help prevent changes in brain function. Your risk may also increase depending on what other health issues you have. Ask your healthcare team about your personal risk factors and ways to prevent side effects to help you make a decision.

Other Options

PCI was the standard of care for decades, but recently the views on whether it should be used can vary from doctor to doctor. Modern scans give highly detailed pictures that show cancer in the brain when it is very small. Having a brain scan every few months helps to catch brain mets early so they can be treated early. One treatment option is to have radiation aimed exactly at the tumor(s), which protects the other parts of the brain. This treatment is called “stereotactic brain radiation therapy (SBRT)” and it can be very effective. In some cases, whole brain radiation (WBR) may be needed if brain mets have already been found and a stronger dose of radiation is needed.

Radiation treatments also have side effects that can impact your decision. Ask your team about potential side effects for each treatment option you’re considering.

Questions for your healthcare team:

  • Based on my diagnosis, stage of cancer and health factors, what is my risk of having brain mets?
  • Based on my health factors, what is my risk of having changes in my memory and other thinking skills from PCI?
  • If I choose PCI, is hippocampal sparing an option for me?
  • If I choose PCI, is medicine to help prevent changes in my memory and thinking skills an option for me? What are the side effects of the medicine?
  • If I don’t choose PCI, how often will I have brain scans?
  • If I don’t choose PCI and brain mets are found, what are my treatment options? How well do they work and what are the side effects?

Second opinion

Seeking a second opinion about your treatment options is always a good idea. It can offer you a different point of view to think about, provide more information and/or it can increase confidence in your decision.

If you’d like to learn more about PCI, your treatment options, how to get a second opinion, or if you have other questions, please contact us through our HelpLine at 1-800-298-2436, support@go2.org or click HERE for more information on our services and support.