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Abstract：
Small cell lung cancer (SCLC) is the most malignant pathological type of lung cancer with the highest mortality, and the incidence of brain metastasis (BM) is in high frequency. So far, prophylactic cranial irradiation (PCI) has been suggested as an effective treatment for preventing brain metastasis of SCLC. PCI has long been applied to limited-stage SCLC (LS-SCLC) patients who have achieved complete remission after radiotherapy and chemotherapy as a standard treatment. However, the neurocognitive decline is a major concern surrounding PCI. New therapeutic approaches targeting PCI-induced neurotoxicity, including hippocampal protection or memantine, have been increasingly incorporated into the therapeutic interventions of PCI. Helical tomotherapy, RapidArc, and Volumetric-modulated arc therapy (VMAT) with a head-tilting baseplate are recommended for hippocampal protection. Besides, in the MRI and immunotherapy era, the significance of PCI in SCLC patients is controversial. SCLC patients with PCI should be recruited in clinical trials since this is the only way to improve the existing standard of care. This review summarizes the current therapeutic strategy and dilemma over PCI for SCLC, providing a theoretical basis for clinical decision-making and suggestions for PCI practice in clinical.
摘要：
小细胞肺癌(SCLC)是恶性程度最高、病死率最高的肺癌病理类型,脑转移（BM）的发生率很高。到目前为止,预防性颅脑照射(PCI)已被认为是预防SCLC脑转移的有效治疗方法.PCI作为标准治疗方法长期应用于放疗和化疗后完全缓解的局限期SCLC（LS-SCLC）患者。然而,神经认知功能下降是PCI的主要关注点.针对PCI诱导的神经毒性的新治疗方法，包括海马保护或美金刚，已越来越多地纳入PCI的治疗干预措施。螺旋断层治疗,RapidArc,建议使用带有头部倾斜基板的体积调节电弧疗法（VMAT）进行海马保护。此外,在MRI和免疫治疗时代，PCI在SCLC患者中的意义存在争议.SCLCPCI患者应在临床试验中招募，因为这是改善现有护理标准的唯一方法。本文总结了SCLCPCI的当前治疗策略和困境。为临床决策提供理论依据,为PCI在临床的实践提供建议。
