Prophylactic Cranial Irradiation (PCI): Prevent Brain Metastases with Expert Care

What is Prophylactic Cranial Irradiation?

Prophylactic cranial irradiation (PCI) is a type of radiotherapy. It aims to prevent cancer from spreading to the brain, especially in patients with small-cell lung cancer (SCLC). PCI works by delivering a low dose of radiation to the entire brain to kill microscopic cancer cells before they grow.

PCI is usually offered after initial treatment, such as chemotherapy or chemoradiotherapy, if the person achieves a partial or complete response. It is part of the standard of care in selected cases and has been shown to reduce the incidence of brain metastases.

Treatment of small cell lung cancer is not complete without a discussion about PCI. While this may not happen at the time of your initial diagnosis, your doctor should speak to you about it during your treatment.

Overview of PCI

PCI uses a carefully planned radiation dose to target the brain. It is different from whole-brain radiotherapy used to treat existing brain metastasis. The goal is to prevent cancer cells from crossing the blood-brain barrier and forming new tumours in the central nervous system.

Modern radiotherapy treatment techniques like hippocampal avoidance and stereotactic radiosurgery can help reduce the risk of memory loss and other side effects. At my practice, I use advanced planning, imaging, and precision delivery to support safer and more effective care.

Purpose in Cancer Treatment

The main role of PCI is to prevent brain metastases in high-risk patients. In small-cell lung cancer, cancer cells often spread to the brain, even when patients respond well to initial treatment.

Studies like the randomised trial and other studies by Takahashi et al. and pooled analysis by Slotman et al. support PCI’s use. The benefit is greatest in patients with extensive disease who achieve a complete remission. This includes many ES-SCLC patients after first-line treatment.

Why PCI is Recommended

The risk of brain metastasis in SCLC can be high without PCI. A trial of prophylactic cranial irradiation showed a significant difference in the incidence of brain metastases between the PCI group and control group.

By treating before visible metastases appear, PCI lowers the chance of symptomatic brain metastases, which often lead to neurological decline and poorer health-related quality of life.

I tend not to offer PCI to elderly patients. We'll discuss the reasons for this and talk about alternatives such as frequent MRI surveillance.

Risk of Brain Metastases in SCLC

SCLC patients, particularly those with limited-stage SCLC or extensive stage SCLC, face a high risk of brain metastases. This is due to the aggressive nature of the disease and its tendency to spread quickly.

You will have had a PET (positron emission tomography) and magnetic resonance imaging (MRI) before starting treatment. Computed tomography (CT) and MRI may not detect early brain spread. PCI helps by addressing this hidden risk early.

Research Supporting PCI Use

A systematic review of randomised clinical trials, including data from J Clin Oncol and N Engl J Med, confirms PCI reduces the relative risk of brain metastases. It also improves progression-free survival and may extend median overall survival.

Evidence from the Department of Radiation Oncology at leading centres and retrospective studies shows a survival benefit in well-selected patients.

Who Benefits from PCI?

Small-Cell Lung Cancer Patients

The use of PCI is well-established in small-cell lung cancer care. It is most often used in:

• Limited-stage SCLC after a partial or complete response

• Extensive stage SCLC after good response to induction therapy

• Patients at high risk of brain metastasis

Other Eligible Cancer Types

While the primary endpoint for PCI studies has been SCLC, PCI is also be considered in:

• Non-small-cell lung cancer (very rarely, in highly select cases)

• Leukaemia (acute lymphoblastic types)

Each case requires a careful assessment by a consultant with experience in Radiation Oncology and Medical Oncology.

The PCI Treatment Journey

Planning and Preparation

Before PCI begins, patients undergo imaging such as MRI and planning scans. This ensures the treatment is tailored to the brain’s shape and protects areas linked to memory and function. I use hippocampal avoidance wherever possible.

A Clinical Nurse Specialist will offer support throughout. Informed consent is obtained after discussing potential side effects and expected outcomes.

During and After Treatment

Patients attend several short treatment sessions over one to two weeks. Each session lasts around 15–20 minutes. The total dose is typically 25 Gy, delivered over 10 fractions over two weeks for people with limited-stage small cell lung cancer.

After PCI, we monitor closely with clinical assessment and follow-up scans. Side effects are tracked and managed quickly.

Benefits of PCI

Lowering Brain Metastasis Risk

Studies show that PCI significantly reduces the risk of brain metastasis in both limited and extensive stage disease. In the PCI group of many trials, fewer patients developed brain involvement compared to the control group.

Potential Survival Advantages

Increased median survival and reduced neurological complications have been seen in certain patient populations. PCI may not be suitable for all, but for selected patients, it provides meaningful benefits.

Managing Side Effects

Short-Term Side Effects

• Fatigue

• Headaches

• Scalp irritation or hair loss

• Nausea or mild confusion

These adverse events only occur in the short-term and at a time that I will be seeing you regularly. We can always address these symptoms quickly to keep you feeling well.

Long-Term Considerations

Some patients may worry about memory loss and reduced neurocognitive function. These risks depend on factors like age, radiation dose, and total treatment volume. We use techniques like hippocampal avoidance to help minimise long-term effects.

Coping Strategies

Our team helps manage side effects with:

• Medication and supportive therapies

• Memory and focus exercises

• Close monitoring with your healthcare team

• Access to local and online support groups

Dr. James Wilson: Expert in Preventive Radiotherapy

Advanced Radiotherapy Expertise

I am a consultant in Radiation Oncology with training from Oxford and the Royal Marsden. I specialise in precision techniques, including PCI and stereotactic radiosurgery, and work with international guidelines and the latest evidence.

Personalised PCI Treatment Plans

Each patient receives a custom plan based on imaging, cancer type, and personal goals. I work closely with Medical Oncology colleagues to ensure PCI fits smoothly into your overall treatment timeline.

Holistic Patient Support

Your care includes emotional, physical, and psychological support. From the first appointment to follow-up, you’ll feel guided and heard.

Access to Leading London Clinics

I provide PCI at trusted hospitals such as The Cromwell Hospital, The London Clinic, and LOC on Harley Street. Private care offers fast access and flexibility to fit your life.

Current Research and Insights

Recent PCI Studies

PCI continues to evolve. Recent trials highlight new approaches, including reduced-dose regimens and improved planning to protect healthy tissue. Pignon JP, Cox JD, and De Ruysscher are among experts contributing to evidence through pooled analysis and review articles.

Evolving Role in Cancer Care

As new therapies emerge, including immunotherapy and better imaging, the role of PCI continues to adapt. The use of PCI remains a key tool for preventing brain metastasis in SCLC patients.

UK Support and Resources

NHS and Private Care Pathways

Patients can access PCI through both NHS and private care. In private settings, wait times are shorter and consultations are faster. I work with both systems to support your needs. Whole brain radiation therapy is available in the NHS, but access to hippocampal avoidance is not available at every centre - if not available where you are, ask for a referral to your nearest university hospital.

Support Groups for Cancer Patients

Support groups can offer advice and emotional support. Ask your Clinical Nurse Specialist or contact organisations such as Macmillan, Roy Castle Lung Cancer Foundation, or the Study of Lung Cancer by the International Association.

Frequently Asked Questions

When is PCI recommended for SCLC?

PCI is offered to SCLC patients who have had a complete or good response to initial treatment, especially those with limited-stage or extensive-stage disease at high risk of brain metastasis.

What side effects should I expect?

Common short-term effects include fatigue, headaches, and hair loss. Long-term effects like memory issues are rare but possible as PCI is associated with an increased risk. We use techniques to reduce risk and monitor closely.

How does Dr Wilson ensure safe PCI delivery?

I use advanced planning, modern imaging, and precise delivery techniques like hippocampal avoidance. Each patient receives a personalised plan and regular review. Patient selection is essential in getting the best results and we'll discuss if PCI is right for you.

Can PCI be combined with other treatments?

Yes. PCI is usually given after chemotherapy or chemoradiotherapy. It may also be used alongside targeted therapy or immunotherapy depending on your individual case.

Connect with Dr James Wilson

Book a Consultation

Find out if PCI is right for you. I offer personalised care and access to advanced radiotherapy techniques.

Call +44 (0)20 7993 6716 or email info@drjameswilson.co.uk to schedule a consultation.

Alternatively, you can click here to book an appointment directly.

Explore Treatment Options

Visit the website: www.drjameswilson.co.uk to learn more about lung cancer treatment and support.