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Prophylactic Cranial Radiotherapy in small cell (oat cell) lung cancer

This has been an issue for decades viz. the high relapse rate of small cell lung cancer in the brain and whether it is sensible to anticipate this relapse problem and forestall it by early brain radiotherapy (the logic here being that it is going to be easier to control microscopic brain disease by radiation rather than to wait for it to become clinically and imaging apparent).
The trial data now point clearly that such ‘anticipatory’ or prophylactic brain radiation therapy is useful in terms of controlling brain disease and improving survival due to this complication. Furthermore, whilst some data in the early 1990’s suggested that such ‘insurance’ policy brain radiotherapy would carry with it some risk of brain damage (particularly neuropsychological sequelae – reduced IQ to the layman) more recent data suggest that these risks are low if the radiotherapy is carried out according to modern guidelines.