Making the case brain radiation for

Dear Dr. Roach: I was diagnosed with small cell lung cancer. After radiation and chemotherapy my chest CT scan is now clear. My radiologist recommended prophylactic brain radiation even though my head CT scan is clear. When I asked how much this would decrease my chances of brain metastasis, he couldn’t give me an answer. He did say that I could develop cognitive impairment.

Is the prophylactic brain radiation worth the risk of losing some cognitive function? What are the chances of developing brain metastasis without this radiation versus with it? — R.L.

I am sorry about your diagnosis, but I applaud you for asking for more information. It is disappointing that the radiologist did not immediately answer you. It is absolutely essential in order for you to make an informed decision.

Small cell lung cancer frequently spreads to the brain. Doctors have been using radiation to the brain for decades to kill any cancer cells that may be there unseen. In people with “limited stage” small cell cancer, the use of brain radiation reduced the incidence of recognized brain disease from 59% to 33%; treatment also improved the three-year survival rate from 15% to 21%.

Cancer and chemotherapy both can have effects on brain function, including not being able to think as clearly or solve problems as well (cognitive impairment). However, brain radiation does cause problems in more people than the other cancer treatments alone. Other brain functions similarly showed greater decline among those treated with radiation.

The improvement in survival rates and freedom from cancer spreading to the brain is significant; however, there is some increased loss of cognitive function. Most people choose to undergo radiation.

I must note that these studies were from years ago.