Background/aim: Prophylactic cranial irradiation (PCI) is a well-established treatment of small cell lung cancer (SCLC) patients following response to initial chemoradiotherapy. The benefit of PCI does, however, come at the cost of cognitive decline. This has been attributed to radiation-induced toxicity at the hippocampus, a crucial anatomic area for cognition. Modern radiotherapy techniques allow dose reduction at the hippocampal region. In this review, the safety profile, effect on cognition, and changes on brain imaging modalities of hippocampal avoidance-PCI (HA-PCI) will be presented, aiming to identify a potential clinical rationale for SCLC patients.
Materials and methods: A systematic review of the literature was performed in Pubmed, Cochrane library databases and ClinicalTrials.gov with no past date limitations until 07/01/2022. Principles as outlined in the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement were followed.
Results: Eight studies published from 2015 to 2021 were included.
Conclusion: HA-PCI is safe, yet its effect on neurocognition and imaging remains unclear, as studies have shown contradictory results.
Keywords: Prophylactic cranial irradiation; hippocampal avoidance; neurocognition; review; small cell lung cancer.
Copyright 2022, International Institute of Anticancer Research.