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Small Cell Lung Cancer Therapy- Whole Brain Radiation- Over-treatment?

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” This is currently an area of debate as Prophylactic Cranial Irradiation (PCI) can have cognitive side effects (such as memory loss), but does appear to improve survival…”

Hi David- I have been diagnosed with Small Cell Lung Cancer. I had surgery to my left upper lobe. The tumor was removed. The tumor was 1 centimeter and no other cancerous cells found. Will have 12 chemotherapy treatments for prevention. Furthermore, after chemo they want to do radiation to my brain (Prophylactic Cranial Irradiation).

I am 60 y/o, working full time and raising grand children. As you can tell, I am nervous about the whole brain radiationPlease give my your thoughts.


Hi Catherine-
Several things. First and foremost, I am sorry to read of your small cell lung cancer diagnosis. Secondly, let me say that you are in charge of what therapies you undergo. Oncology may recommend therapies based on previous experience, research, who knows what. But you have to do what you think is right for you.
Having said that, I have to say that by asking for my advice, you are questioning your oncologist’s recommendation to undergo whole brain radiation. Especially since you are already undergoing 12 chemo treatments for “prevention” as you say.
When you say that the tumor found in your upper lobe was one centimeter, I am guessing that this is a relatively small tumor. Combined with the fact that your cancer has not spread (“no other cancerous cells found), you believe that our small cell lung cancer is local, not regional and not systemic.
According to the article linked and excerpted below, you are “limited stage small cell lung cancer.”
I am also 60 years old. Though I am a cancer survivor myself, I make decisions based on the assumption that I will live for decades to come. I think that you should make treatment decisions this way as well.
I think your decision comes down to weighing the risks and benefits of more or less treatment. More treatment being “they want to do radiation to my brain.”
If you undergo both surgery and chemotherapy, both to kill/remove lung cancer from your body, what is your risk of relapse? In other words, a local, 1 cm tumor, is considered to be early stage? Perhaps SCLC stage one?
  • What is the published risk of relapse of stage 1 SCLC that is surgically removed?
  • If you undergo 12 rounds of chemotherapy, what is the published risk of side effects, secondary cancers, organ damage, etc. caused by this “preventive” chemotherapy?
  • If you undergo whole brain radiation, what is the published risk of side effect, secondary cancers, brain damage, etc. cause by this “preventive” radiation?


I apologize for asking all these silly questions above. I’m just trying to illustate how I think and how you should think- what questions you should consider before making any sort of decision.
And by the way, you should be able to ask your oncologist any/all of the questions above. All board-certified oncologists should be able to explain your risks of side effects cause by both “preventive” chemotherapy and radiation.
Evidence-based non-conventional therapies to reduce your risk of relapse include:
  • prehabilitation
  • curcumin
  • green tea extract
  • resveratrol, others


Yes, my guess is that there is a small risk of your SCLC relapsing. However I believe that the risk of side effects from both your chemotherapy and proposed radiation is greater.
Thanks and good luck.
David Emerson
  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Limited Stage Small Cell Lung Cancer Overview

“Limited stage small cell lung cancer is the earliest stage of the disease. Unlike non-small cell lung cancer, small cell lung cancer is divided into only two stages; limited stage and extensive stage.

Surgery is performed much less commonly with non-small cell lung cancer, with the mainstay of treatment being chemotherapy and radiation therapy. That said, after years of little progress in treatment, new options are being evaluated in clinical trials including the use of immunotherapy drugs…

Definition- Limited stage small cell lung cancer involves cancer that is present in only one lung and may have spread to nearby lymph nodes or the tissue between the lungs, but has not spread (metastasized) to other regions of the body…

Surgery- Surgery is rarely performed for small cell lung cancer (it is usually considered inoperable) but is occasionally considered if a tumor is present in only one lung and nearby lymph nodes. Adjuvant chemotherapy (chemotherapy after surgery) is usually recommended if surgery is done for small cell lung cancer.

Prophylactic Cranial Irradiation- If individuals respond well to treatment (have either a complete or partial respond to chemotherapy and radiation), prophylactic cranial irradiation(PCI)—preventative radiation therapy to the brain—is sometimes recommended to lower the risk that any cancer cells that have spread to the brain (but aren’t seen on radiology studies) will grow and cause symptoms. This is currently an area of debate as PCI can have cognitive side effects (such as memory loss), but does appear to improve survival…”




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