{"entity":{"id":"pci-overview-1999","kind":"trial","name":"Prophylactic Cranial Irradiation Overview (Auperin meta-analysis)","aka":["PCI Overview","Auperin meta-analysis"],"tldr":"Pooling seven trials showed that irradiating the brain before any tumour appears there adds about five people alive in a hundred at three years.","summary":"Small-cell lung cancer seeds the brain early and the blood-brain barrier keeps chemotherapy out, so brain relapse is common even in patients whose chest disease has cleared. Individual trials of prophylactic cranial irradiation each showed fewer brain metastases but none was large enough to show a survival gain. The Prophylactic Cranial Irradiation Overview Collaborative Group pooled individual data on 987 patients in complete remission from seven randomised trials.\n\nThe relative risk of death with irradiation was 0.84 (95 percent confidence interval 0.73 to 0.97, p=0.01), corresponding to three-year survival of 20.7 percent against 15.3 percent, a 5.4 percent absolute gain. Disease-free survival also improved (relative risk of recurrence or death 0.75, 0.65 to 0.86).\n\nThe meta-analysis made prophylactic cranial irradiation standard in limited-stage disease that has responded, and Slotman's EORTC 08993 extended it to extensive-stage disease in 2007. Both are now qualified: the Japanese trial by Takahashi, which required a brain MRI at baseline and three-monthly MRI surveillance afterwards, found no survival benefit and a numerically worse result with irradiation, so in centres that can offer MRI surveillance the choice is genuinely open, and neurocognitive cost is weighed against a benefit measured in a pre-MRI era. Hippocampal avoidance is the current attempt to keep the benefit and lose the cost.","status":"positive","asOf":"2026-09-25","links":[{"label":"Prophylactic Cranial Irradiation Overview (New England Journal of Medicine 1999)","url":"https://doi.org/10.1056/NEJM199908123410703"}],"tags":[],"related":[],"cancers":["limited-stage-sclc","extensive-stage-sclc","sclc"],"sections":[],"technologies":["imrt-igrt"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["brain-metastases","curative-intent"],"trials":["slotman-pci-es-sclc","takahashi-pci"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"phase":"observational","setting":"Small-cell lung cancer in complete remission after chemotherapy, with or without thoracic radiotherapy: prophylactic cranial irradiation versus none, pooled from seven randomised trials, with overall survival as the endpoint","sponsor":"Prophylactic Cranial Irradiation Overview Collaborative Group","result":"Relative risk of death 0.84 (95 percent confidence interval 0.73 to 0.97, p=0.01); three-year survival 20.7 against 15.3 percent.","yearReported":1999,"enrolled":987,"enrolledBasis":"analysed","enrolledNote":"Individual data on 987 patients from seven randomised trials; it is a meta-analysis, not a trial with its own registration.","outcomes":[{"endpoint":"Overall survival at 3 years","primary":true,"unit":"%","arms":[{"name":"Prophylactic cranial irradiation","value":20.7},{"name":"No prophylactic cranial irradiation","value":15.3}],"hr":0.84,"ci":[0.73,0.97],"p":"0.01","source":"https://doi.org/10.1056/NEJM199908123410703"}],"replication":"EORTC 08993 (Slotman) reproduced the effect in extensive-stage disease; the Japanese trial of Takahashi, with MRI surveillance, did not, and is the reason the practice is now a discussion."},"route":"/trials/pci-overview-1999/","neighbours":{"cancer":[{"id":"extensive-stage-sclc","kind":"cancer","name":"Extensive-stage small-cell lung cancer","route":"/cancers/extensive-stage-sclc/"},{"id":"limited-stage-sclc","kind":"cancer","name":"Limited-stage small-cell lung cancer","route":"/cancers/limited-stage-sclc/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"}],"technology":[{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"}],"term":[{"id":"brain-metastases","kind":"term","name":"Brain metastases (intracranial disease)","route":"/terms/brain-metastases/"},{"id":"curative-intent","kind":"term","name":"Curative intent vs palliative intent","route":"/terms/curative-intent/"}],"trial":[{"id":"slotman-pci-es-sclc","kind":"trial","name":"EORTC 08993 (Slotman): prophylactic cranial irradiation in extensive-stage small-cell lung cancer","route":"/trials/slotman-pci-es-sclc/"},{"id":"takahashi-pci","kind":"trial","name":"Takahashi trial: prophylactic cranial irradiation with MRI surveillance in extensive-stage small-cell lung cancer","route":"/trials/takahashi-pci/"}]}}