Lung cancer is one of the most common cancers in the United States, with small cell lung cancer (SCLC) making up about 15 out of every 100 (15%) cases. Like many other types of cancer, lung cancer can spread to the brain and start growing there. This is especially common for SCLC. When this happens, it’s called brain metastases or brain mets. It’s not brain cancer; it’s lung cancer that has spread to the brain. 

If you have a diagnosis of SCLC, your healthcare team may discuss the risk of brain metastases, ways to manage that risk, and your treatment options if brain mets occur. It’s important to understand all your choices and openly discuss any questions you have with your healthcare team. This helps you gain the information needed to make informed decisions about your care. 

Managing your risk of SCLC brain metastases

There are ways you and your healthcare team can manage your risk of developing SCLC brain mets, including: 

  • Magnetic resonance imaging (MRI) scans
    Regularly scheduled MRI scans are the best way to detect brain metastases early, when they are easier to treat. MRI scans use strong magnets to create highly detailed images of the brain. These scans can detect very small changes and are usually scheduled every 3 months. If brain mets are seen on your MRI, your healthcare team will discuss treatment options with you. 
  • MRI scans and prophylactic cranial irradiation (PCI)
    Depending on the stage of SCLC you are diagnosed with, your healthcare team may discuss PCI as an option. PCI is a low-dose radiation treatment given to the whole brain to lower the future risk of brain mets. Its goal is to destroy SCLC cells that may be present in the brain, which are too small to detect on MRI scans. PCI is only an option when your brain MRI shows no signs of cancer. 

    Brain     mets can still develop even after PCI treatment, and there are risks of long-term side effects with PCI that can impact memory and other thinking skills. Talk to your healthcare team about the benefits and risks of PCI. 

Managing SCLC brain metastases

If your MRI shows brain mets, your healthcare team will discuss your treatment options with you. These options depend on the location and number of metastases, when they are found, your previous treatments, and your overall health and personal goals. Treatment for brain mets can include: 

  • Whole-brain radiation (WBR) delivers radiation to the whole brain. Typically used when there are many brain metastases. 
  • Stereotactic radiosurgery (SRS) delivers focused beams of radiation to a specific area of the brain. Used when there is a limited number of brain metastases. 
  • Immunotherapy helps your immune system to find and destroy cancer cells. Some types of immunotherapy drugs can cross into the brain and destroy cancer cells located there.  
  • Surgery to remove brain mets may be an option, depending on the location and the number of metastases. 
  • Clinical trials are research studies done to determine whether a new treatment or combination of treatments is safe and effective. It’s always good to explore clinical trials and discuss your options with your healthcare team. For help finding clinical trials, contact our navigators through our free HelpLine 1-800-298-2436 or email support@go2.org.   

Whole brain radiation (WBR) versus prophylactic cranial radiation (PCI) 

Sometimes there is confusion between WBR and PCI. While they may sound similar, they are very different and are used for different reasons. Here’s a breakdown in simple terms. 

WBR 
  • When
    WBR is given when SCLC has already spread to the brain. 
  • Why
    The goal is to treat cancer that is already there. Radiation covers the entire brain to target both visible tumors and cancer cells that may not show up on scans. 
  • What to expect
    WBR usually occurs over several treatments, spaced over days or weeks. Common side effects can include fatigue, hair loss, memory or thinking changes, and skin irritation. 
PCI 
  • When
    PCI is given when scans do not detect cancer in the brain. It aims to prevent lung cancer from spreading there. PCI’s goal is to destroy SCLC cells that are too small to be seen on an MRI.  
  • Why
    The goal is prevention. By treating the whole brain early, PCI can lower the risk of lung cancer spreading to the brain. 
  • What to expect
    PCI is usually given in smaller total doses than WBR. Common side effects can be similar, such as fatigue and changes in memory and thinking skills.  
The key difference
  • WBR = treatment for brain metastases that already exist 
  • PCI = prevention, used before metastases appear, low-dose radiation 

Summary 

Understanding how SCLC can affect the brain and the ways to manage your brain health can help you feel more prepared and confident in your care. Having regular MRI scans and thoughtful discussions with your healthcare team about what is important to you in your care can result in an approach to managing SCLC that is just right for you. 

If you’d like to learn more about SCLC, have questions, or need support, please contact our free HelpLine at 1-800-298-2436 or email support@go2.org.