Prophylactic cranial irradiation PCI
Prophylactic cranial irradiation (PCI) is treatment to prevent or reduce the risk of cancer cells spreading to the brain.
What is prophylactic cranial irradiation (PCI)?
Prophylactic cranial irradiation (PCI) is radiotherapy to the head. It is given to prevent or reduce the risk of cancer cells spreading to the brain or growing into a tumour. Prophylactic means preventive, and cranial means the head. PCI is sometimes called prophylactic cranial radiotherapy (PCR).
Chemotherapy is a very helpful treatment for different cancers, but it might not help if cancer cells have spread to the brain. This is because the brain is protected by a membrane called the blood-brain barrier. This barrier prevents a lot of chemotherapy drugs from getting to the brain.
PCI can be an effective treatment for certain cancers where there is a risk of cancer cells spreading to the brain.
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When PCI is given
Your cancer doctor might talk to you about having PCI if you have:
- limited stage small cell lung cancer (SCLC) and the cancer has responded well to treatment with chemoradiation
- extensive stage SCLC and the cancer has responded well to your first treatment
- a rare type of fast-growing non-Hodgkin lymphoma called lymphoblastic lymphoma.
PCI is not suitable for everyone. It can cause different side effects. You also need to be well enough to have it. Your doctor or nurse will talk to you about the possible advantages and disadvantages before you make your decision.
How PCI is given
Radiotherapy uses high-energy rays called radiation to treat cancer. It destroys cancer cells in the area where the radiotherapy is given.
You have radiotherapy in a hospital radiotherapy department. The radiotherapy itself only lasts for a few minutes but it can take 10 minutes or longer to get you prepared. Your doctor or nurse will tell you how many treatment sessions you will have.
Your radiotherapy is carefully planned to make sure it works as well as possible. You will have a mask made from a plastic mesh. You wear this during your treatment to help keep your head still. You can breathe through the mask, and it should not be uncomfortable.
At the beginning of each session of radiotherapy, the radiographer positions you carefully on the couch and makes sure you are comfortable. You are alone in the room during treatment. But you can talk to the radiographer, who is watching from the next room.
Plastic mesh radiotherapy mask
Side effects of PCI
Each person’s reaction to radiotherapy is different. Some people have very few side effects, and other people have more. Usually, the side effects of PCI are mild. Side effects sometimes get a little worse in the first 2 weeks after treatment finishes. But after this they will improve. If you are worried about side effects or they do not improve, always contact your radiotherapy team.
Hair loss
You will lose your hair in the area being treated when you have PCI, but this is usually temporary. Your hair may start to fall out about 3 weeks after your first treatment. It usually starts to grow back 1 to 2 months after you finish treatment. Sometimes it grows back a slightly different colour and texture than it was before, and it may not be as thick.
Tiredness
Radiotherapy can make you tired. You may feel tired for weeks or months after PCI has finished.
Some people may develop extreme tiredness a few weeks after radiotherapy has finished. You may:
- have very little energy
- feel sleepy
- spend a lot of time sleeping.
Usually, this will slowly get better over a few weeks.
Headaches
Some people have headaches during treatment. You may get headaches in the first few days after starting PCI. It is important to tell the staff looking after you if you have a headache. Your doctor may prescribe painkillers, or sometimes steroids.
Feeling sick
You may feel sick (nauseous), but this is not common. Feeling sick can usually be treated with anti-sickness drugs (anti-emetics). Your doctor can prescribe these. Tell your doctor if it does not get better. They can prescribe other anti-sickness drugs that may be more effective, or steroids.
Loss of appetite
You may lose your appetite. If this happens you can supplement what you eat with nutritious, high-calorie drinks. These are available from most chemists. Your GP can also prescribe them. A dietitian or specialist nurse at your hospital can give you advice.
Skin changes
Your healthcare team will advise you on how to look after your skin. Do not put anything on the treated area of your skin before checking with your nurse or radiographer.
Wash your hair or scalp gently with mild shampoo and lukewarm or cool water. Gently pat your hair or scalp dry with a soft towel. Do not rub it, and do not use a hairdryer.
You may have a mild skin reaction after PCI. The treated skin might become itchy and sore behind the ears. If you have white skin the treated area might become red. If you have black or brown skin the skin in the area might become darker.
Staff in the radiotherapy department will check your skin for a reaction. Tell them if you notice any changes or feel any soreness.
The skin in the treated area will be sensitive. You will need to avoid exposing your head to the sun during treatment and for at least 1 year afterwards. Wear a scarf or hat to protect your head from the sun or cold. Use a sun protection factor (SPF) of 50 after treatment when any skin reaction has gone.
Late side effects of PCI
Late effects are side effects of treatment that might not happen until months or years after treatment. Your doctor will talk to you about the risk of late effects before your radiotherapy starts.
Radiotherapy to the brain may cause changes to your memory, thinking and reasoning. After treatment, you might find your memory is not as good as it was, or you might have difficulty concentrating.
Your doctors can explain more about this. They will discuss with you the risk of this happening compared to the benefit of having PCI. The effects on memory are more likely to happen in older people who have PCI.
Your feelings about PCI
Everyone has their own way of coping with difficult situations. You may find it helpful to talk to family or friends. Or you may prefer to seek help from people outside your situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is there if you need it. Our cancer support specialists can give you information about counselling in your area.
Macmillan is also here to support you. If you would like to talk, you can:
- Call the Macmillan Support Line for free on 0808 808 00 00.
- Chat to our specialists online
- Visit our lung cancer forum to talk with people who have been affected by lung cancer, share your experience, and ask your questions.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our lung cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
National Institute for Health and Care Excellence (NICE). Lung cancer – Diagnosis and management. Clinical guideline 2019. Last updated 2023. (accessed Nov 2023) Available at: https://www.nice.org.uk/guidance/ng122
European Society for Medical Oncology (ESMO). Small-cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. 2021. (accessed Nov 2023). Available at: https://www.esmo.org/guidelines/guidelines-by-topic/esmo-clinical-practice-guidelines-lung-and-chest-tumours/small-cell-lung-cancer
European Society for Medical Oncology (ESMO). Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. 2017. eUpdate 01 September 2021: New Locally Advanced NSCLC Treatment Recommendations (accessed Nov 2023) Available at: https://www.esmo.org/guidelines/esmo-clinical-practice-guideline-early-stage-and-locally-advanced-non-small-cell-lung-cancer
European Society for Medical Oncology (ESMO). ESMO expert consensus statements on the management of EGFR mutant non-small-cell lung cancer. 2022 (accessed Nov 2023). Available at: https://pubmed.ncbi.nlm.nih.gov/35176458/
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