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Abstract Object  Prophylactic cranial irradiation (PCI) is commonly offered to patients with limited stage primary small cell lung cancer following a complete response. Methods  We present the unique case of a 76-year-old woman treated with PCI with a dose of 30 Gy in 15 fractions, at 200 cGy per fraction who developed progressive dementia. Conclusions  This is the first reported case of dementia from PCI at this low dose per fraction. Patients need to be counseled regarding the risks and benefits of treatment, including dementia with treatment and risk of sequelae from CNS metastasis without treatment. The authors review the data supporting PCI and the incidence of radiation associated dementia. [ABSTRACT FROM AUTHOR]