# Prophylactic cranial irradiation vs MRI surveillance

Source: https://onco.cc/technologies/prophylactic-cranial-irradiation/  
OnCo record `prophylactic-cranial-irradiation` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

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.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-09-07
- Principle: Whole-brain radiotherapy to sterilise micrometastases before they become symptomatic; MRI surveillance instead detects and treats them early with stereotactic radiosurgery.
- Strengths: Halves brain metastasis incidence; Survival benefit in limited-stage disease with older staging
- Limitations: Neurocognitive decline; Benefit unclear when MRI surveillance is available; Ongoing trial will settle the question

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Prophylactic_cranial_irradiation
- Wikipedia: https://en.wikipedia.org/wiki/Prophylactic_cranial_irradiation

## Connected records

- cancers: [Extensive-stage small-cell lung cancer](https://onco.cc/cancers/extensive-stage-sclc/), [High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL)](https://onco.cc/cancers/all-paediatric-high-risk/), [Limited-stage small-cell lung cancer](https://onco.cc/cancers/limited-stage-sclc/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/)
- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/)
- technologies: [Gamma Knife](https://onco.cc/technologies/gamma-knife/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [MRI](https://onco.cc/technologies/mri/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/)
- terms: [Limited-stage vs extensive-stage (small-cell lung cancer)](https://onco.cc/terms/limited-extensive-stage/), [Prophylactic cranial irradiation (PCI)](https://onco.cc/terms/pci-term/), [Whole-brain radiotherapy (WBRT)](https://onco.cc/terms/wbrt/)
- trials: [ADRIATIC](https://onco.cc/trials/adriatic/), [EORTC 08993 (Slotman): prophylactic cranial irradiation in extensive-stage small-cell lung cancer](https://onco.cc/trials/slotman-pci-es-sclc/), [Takahashi trial: prophylactic cranial irradiation with MRI surveillance in extensive-stage small-cell lung cancer](https://onco.cc/trials/takahashi-pci/)
- ideas: [Measure brain metastasis prevention as a primary endpoint, not as a secondary one](https://onco.cc/ideas/idea-lung-brain-metastasis-prevention-as-a-primary-endpoint/), [MRI surveillance replaces prophylactic cranial irradiation in SCLC](https://onco.cc/ideas/idea-mri-surveillance-replaces-pci/)
- key papers: [ADRIATIC: durvalumab after chemoradiotherapy for limited-stage small-cell lung cancer](https://onco.cc/key-papers/paper-adriatic-nejm-2024/), [Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN)](https://onco.cc/key-papers/paper-paz-ares-caspian-durvalumab-es-sclc-lancet-2019/), [Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission](https://onco.cc/key-papers/paper-auperin-prophylactic-cranial-irradiation-sclc-nejm-1999/)
- bottlenecks: [The brain: barrier and sanctuary](https://onco.cc/bottlenecks/b-brain-delivery/)
- pathways: [The blood-brain barrier & brain metastasis](https://onco.cc/pathways/blood-brain-barrier-metastasis/)
- roadmaps: [Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH](https://onco.cc/roadmaps/radiation-roadmap/)

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