While PCI is a recommended component of aggressive multimodality treatment for LD-SCLC, PCI does not at this time have any clear role in the treatment of NSCLC. To be potentially valuable, the risk of brain metastases needs to be high enough to justify to potential side effects, time, and expense of PCI, and is likely to be of value only if the risk of cancer recurrence elsewhere is low enough to make risk of brain recurrence a limiting factor in survival. With stage I and II disease, the risk of brain recurrence is not especially high compared with the risk of disease in the rest of the body, and in stage IV disease, control outside of the brain is usually a more pressing issue. But in stage III, or locally advanced NSCLC, as we have gotten better at controlling cancer in the chest, dealing with the potential for cancer in the brain has become enough of a problem that PCI for stage III disease is now a very timely question. Read the rest of this entry »