Prophylactic cranial irradiation vs MRI surveillance
Small-cell lung cancer spreads to the brain so often that doctors used to irradiate the whole brain pre-emptively. Regular MRI scans are now challenging that practice.
PCI (25 Gy in 10 fractions) reduced brain metastases and improved survival in limited-stage disease in the 1999 meta-analysis and in extensive-stage disease in the 2007 EORTC trial (which did not use MRI staging). A Japanese trial (Takahashi 2017) with MRI surveillance showed no survival benefit in extensive-stage disease. Hippocampal-avoidance PCI (PREMER, NRG CC003) reduces cognitive harm. The MAVERICK/SWOG S1827 trial of PCI versus MRI surveillance is the definitive test; results pending.
How it works
Whole-brain radiotherapy to sterilise micrometastases before they become symptomatic; MRI surveillance instead detects and treats them early with stereotactic radiosurgery.
- Halves brain metastasis incidence
- Survival benefit in limited-stage disease with older staging
- Neurocognitive decline
- Benefit unclear when MRI surveillance is available
- Ongoing trial will settle the question
Latest papers
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