Prophylactic Cranial Irradiation (PCI)

Prophylactic means preventative and cranial means head. Prophylactic cranial irradiation (PCI) is used to prevent cancer from spreading (metastasizing) to your brain from primary tumors in other areas of your body that can spread to the brain.

When is PCI given?

The blood-brain barrier is made up of tissues and vessels that filter what can get into the brain. Cancer cells in the brain can be hard to treat because there are only certain chemotherapy medications that can pass through the blood-brain barrier. To prevent cancer cells from growing in the brain, PCI can be given. PCI may be used to treat:

• Small cell lung cancer (SCLC).
• Acute lymphoblastic leukemia (ALL).
• Lymphoblastic lymphoma.

How is PCI given?

PCI is planned and treated like traditional radiation therapy, but the amount of radiation given with PCI is much less than the amount given for primary brain cancers (tumors that started in the brain). Radiation will be given once or twice a day. If you are getting two treatments a day, you will have a 6 to 8-hour break between treatments.

What are the side effects of PCI?

Treatment can affect each patient differently, and you may not have any of these side effects. Side effects of PCI are usually mild.

Acute (short-term) side effects may include:

• Fatigue is very common with radiation. Fatigue often goes away slowly over the weeks and months after treatment.
• Hair loss may happen on your head where you received radiation. Hair often starts to regrow a few months after treatment. However, your hair might not grow back exactly as it was before treatment and for some, the hair loss becomes permanent.
• Nausea and Vomiting is a “sick” or “queasy” feeling in your stomach. Vomiting or “throwing up” often goes along with nausea.
• Skin irritation: The skin on your head may become red, irritated, dry, or sensitive. Treat the skin gently to avoid further irritation Wear a hat to avoid sun exposure. Sun can worsen the irritation.
• Loss of appetite is when you do not feel hungry or have no interest in eating. It is important to keep yourself well-nourished and to stay hydrated.

Chronic (long-term) effects may include:

• Neurocognitive impairment (changes in how your brain works) like memory loss, confusion, and trouble concentrating.
• Changes in your vision.
• Trouble moving around and unsteadiness.
• Trouble doing everyday tasks.

If you start to have any new or worsening side effects, you should talk to your care team.

Is PCI right for me?

Talk with your provider about your diagnosis and whether PCI should be part of your treatment plan. Your provider can go over the benefits and risks of preventative treatment. Together with your provider, you can decide if PCI is the best choice for your long-term cancer care.