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Prophylactic cranial irradiation in small-cell lung cancer: update on patient selection, efficacy and outcomes

Over 10% of small-cell lung cancer (SCLC) patients have brain metastases (BM) at initial diagnosis; more than 50% will develop BM within 2 years. BM are detected in up to 80% of all patients at autopsy. After primary treatment, prophylactic cranial irradiation (PCI) has been established as standard...

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Autores principales: Manapov, Farkhad, Käsmann, Lukas, Roengvoraphoj, Olarn, Dantes, Maurice, Schmidt-Hegemann, Nina-Sophie, Belka, Claus, Eze, Chukwuka
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181088/
https://www.ncbi.nlm.nih.gov/pubmed/30323698
http://dx.doi.org/10.2147/LCTT.S137577
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author Manapov, Farkhad
Käsmann, Lukas
Roengvoraphoj, Olarn
Dantes, Maurice
Schmidt-Hegemann, Nina-Sophie
Belka, Claus
Eze, Chukwuka
author_facet Manapov, Farkhad
Käsmann, Lukas
Roengvoraphoj, Olarn
Dantes, Maurice
Schmidt-Hegemann, Nina-Sophie
Belka, Claus
Eze, Chukwuka
author_sort Manapov, Farkhad
collection PubMed
description Over 10% of small-cell lung cancer (SCLC) patients have brain metastases (BM) at initial diagnosis; more than 50% will develop BM within 2 years. BM are detected in up to 80% of all patients at autopsy. After primary treatment, prophylactic cranial irradiation (PCI) has been established as standard of care in SCLC patients responding to initial therapy. Based on level I evidence, PCI significantly decreases the risk of intracranial relapse and shows a modest survival benefit after 3 years. However, the role of PCI in defined patient subgroups such as resected SCLC, elderly and extensive stage patients with access to magnetic resonance imaging surveillance and stereotactic radiotherapy is yet to be fully clarified. Furthermore, strategies to effective prevention of neurocognitive decline after PCI remain unclear. All these factors significantly impact treatment decision making and should be evaluated in prospective settings. New concepts such as hippocampal avoidance and drug neuroprotection prevent chronic neurocognitive effects reducing treatment-related side effects of PCI. The aim of this review is to present a summary and update of the latest evidence for patient selection, efficacy and outcome of PCI.
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spelling pubmed-61810882018-10-15 Prophylactic cranial irradiation in small-cell lung cancer: update on patient selection, efficacy and outcomes Manapov, Farkhad Käsmann, Lukas Roengvoraphoj, Olarn Dantes, Maurice Schmidt-Hegemann, Nina-Sophie Belka, Claus Eze, Chukwuka Lung Cancer (Auckl) Review Over 10% of small-cell lung cancer (SCLC) patients have brain metastases (BM) at initial diagnosis; more than 50% will develop BM within 2 years. BM are detected in up to 80% of all patients at autopsy. After primary treatment, prophylactic cranial irradiation (PCI) has been established as standard of care in SCLC patients responding to initial therapy. Based on level I evidence, PCI significantly decreases the risk of intracranial relapse and shows a modest survival benefit after 3 years. However, the role of PCI in defined patient subgroups such as resected SCLC, elderly and extensive stage patients with access to magnetic resonance imaging surveillance and stereotactic radiotherapy is yet to be fully clarified. Furthermore, strategies to effective prevention of neurocognitive decline after PCI remain unclear. All these factors significantly impact treatment decision making and should be evaluated in prospective settings. New concepts such as hippocampal avoidance and drug neuroprotection prevent chronic neurocognitive effects reducing treatment-related side effects of PCI. The aim of this review is to present a summary and update of the latest evidence for patient selection, efficacy and outcome of PCI. Dove Medical Press 2018-08-16 /pmc/articles/PMC6181088/ /pubmed/30323698 http://dx.doi.org/10.2147/LCTT.S137577 Text en © 2018 Manapov et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Review
Manapov, Farkhad
Käsmann, Lukas
Roengvoraphoj, Olarn
Dantes, Maurice
Schmidt-Hegemann, Nina-Sophie
Belka, Claus
Eze, Chukwuka
Prophylactic cranial irradiation in small-cell lung cancer: update on patient selection, efficacy and outcomes
title Prophylactic cranial irradiation in small-cell lung cancer: update on patient selection, efficacy and outcomes
title_full Prophylactic cranial irradiation in small-cell lung cancer: update on patient selection, efficacy and outcomes
title_fullStr Prophylactic cranial irradiation in small-cell lung cancer: update on patient selection, efficacy and outcomes
title_full_unstemmed Prophylactic cranial irradiation in small-cell lung cancer: update on patient selection, efficacy and outcomes
title_short Prophylactic cranial irradiation in small-cell lung cancer: update on patient selection, efficacy and outcomes
title_sort prophylactic cranial irradiation in small-cell lung cancer: update on patient selection, efficacy and outcomes
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181088/
https://www.ncbi.nlm.nih.gov/pubmed/30323698
http://dx.doi.org/10.2147/LCTT.S137577
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