Cerebral metastases: prophylaxis and treatment

Small cell lung cancer (SCLC) is characterized by a high prevalence of brain metastases, which affect more than half of the patients during the course of the disease. Since the meta-analysis of the late 1990s prophylactic cranial irradiation is a key element in multimodal therapy of limited disease SCLC with complete remission after chemotherapy. Recently, moreover, a multicenter phase III study in patients with advanced disease demonstrated a survival advantage following prophylactic radiotherapy to the brain. In the palliation of cerebral metastases whole brain radiotherapy remains the standard of treatment. The poor survival rates, however, strongly support the need for effective prophylaxis.