If you or a loved one has been diagnosed with small-cell lung cancer (SCLC), you may hear your care team talk about prophylactic cranial irradiation, or PCI. This preventative treatment may have important implications for a patient’s long-term, overall health outcomes. After being diagnosed with SCLC, it’s important to understand what PCI is and why it matters.
What is PCI?
Prophylactic cranial irradiation (PCI) is radiation therapy to the brain given before any cancer is visible there. Care teams consider PCI, typically after chemotherapy or chest radiation, if the SCLC tumors are responding well to treatment and the patient currently has no signs of brain metastases (which would mean the SCLC had spread to the brain). When SCLC spreads to the brain, it is considered metastatic, which means that while the cancer can be treated, it’s not curable.
SCLC behaves differently from other types of lung cancer in several ways. It grows quickly and frequently spreads early, and up to 80% of patients with SCLC develop brain metastases. Unfortunately, many chemotherapy drugs can’t treat tumors in the brain because of the blood–brain barrier.
How does PCI support SCLC patients?
If a patient responds well to PCI, they can avoid brain metastases and the symptoms that can accompany them, including: headaches, seizures, memory loss, personality shifts, mobility issues, speech issues–all of which can greatly (and negatively) influence quality of life.
For patients with SCLC that hasn’t yet metastasized, PCI can prevent lung cancer tumors from developing in the brain, which can also prolong the patient’s life.
For extensive-stage SCLC (cancer that has already spread), PCI can lower the risk of brain metastases, but its impact on overall survival is less clear. Because of this, some patients may be offered regular MRI brain scans instead of PCI, depending on their situation.
It’s important to speak with your care team about all of your options, and their potential side effects. For example, short-term side effects of PCI include:
- Fatigue
- Hair loss
- Headaches
- Nausea
Long-term risks of PCI can include:
- Memory loss
- Difficulty concentrating
- Cognitive issues
When diagnosed with SCLC, speak with your care team about all of your options–but, make sure to broach the topic of PCI. Your doctor will assess both your overall health and your personal preferences to determine if PCI or periodic brain imagery (such as an MRI) is better suited to your care plan.
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