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Prophylactic cranial irradiation (PCI)

aka PCI, cranial irradiation

Giving the brain a preventive dose of radiation when a cancer is very likely to spread there, before any metastasis can be seen; mainly small-cell lung cancer.

Small-cell lung cancer spreads to the brain in over half of patients, and PCI (25 Gy in 10 fractions) halved brain relapse and improved survival in limited-stage disease in the 1990s meta-analysis. Its value in extensive-stage disease and in the era of routine MRI staging is disputed (the Japanese Takahashi trial found no benefit with MRI surveillance), so the SWOG S1827 MAVERICK trial is comparing PCI with MRI surveillance while cognitive side effects push practice toward surveillance. In childhood leukaemia it has been replaced by intrathecal chemotherapy.

Category
Procedures

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