Should current management of small cell lung cancer include prophylactic cranial irradiation?

The literature on the use of prophylactic cranial irradiation (PCI) in the management of small cell lung cancer (SCLC) is reviewed, focusing on the ten randomized trials published until 1991. Eight out of ten randomized trials have shown some reduction in the frequency of CNS relapse in patients who have had PCI, whereas none have shown any survival benefit associated with PCI. Current data indicate that survival is exclusively dependent on an effect of PCI in only a very limited subgroup of patients (10% of complete responders). It is generally agreed that PCI is not justified in patients who are not in CR, but even in this situation it is unknown whether PCI is necessary. The current therapeutic potentials seem to leave comparable fractions of patients without sufficient palliation of their symptomatic brain metastases regardless of whether or not PCI is given. Data from sufficiently large randomized trials have to be matured and analyzed, before the role of PCI in SCLC can be defined.