Bestrahlung des zentralen Nervensystems beim kleinzelligen Lungenkarzinom

Up to 80% of patients with small cell lung cancer (SCLC) develop brain metastases, which are a significant cause of neurological morbidity and mortality. Cranial radiotherapy is indicated in many cases.

This work aims to describe and explain the role of radiotherapy in this context.

The study comprises a critical review of high-quality international literature and evidence.

Prophylactic cranial irradiation (PCI) improves overall survival in disease of limited stage according to the Veterans Administration Lung Cancer Study Group (LS-SCLC) with a good response to primary treatment. It should not exceed a dose of 30 Gy, can be performed with hippocampal sparing, and should be initiated sequentially and promptly after completion of primary therapy. The possible influence of consolidation immunotherapy on the benefit of PCI is still unclear. In extensive disease (ES-SCLC), PCI can be offered to fit patients or those with poor compliance as an alternative to regular MRI brain imaging. In the therapeutic setting, there is a paradigm shift from whole-brain radiotherapy to stereotactic radiotherapy and radiosurgery. Due to the better preservation of neurocognition, there is growing acceptance of stereotactic radiation in fit patients with a limited number of brain metastases, either as sole treatment or as an integrated dose escalation during whole-brain radiotherapy. Ongoing trials will further define the exact role of radiotherapy in these contexts.