{"entity":{"id":"prophylactic-cranial-irradiation","kind":"technology","name":"Prophylactic cranial irradiation vs MRI surveillance","aka":[],"tldr":"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.","status":"established","asOf":"2026-09-07","wikipedia":"https://en.wikipedia.org/wiki/Prophylactic_cranial_irradiation","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Prophylactic_cranial_irradiation"}],"tags":[],"related":[],"cancers":["sclc"],"sections":["radiation"],"technologies":["mri","sbrt","imrt-igrt"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["limited-extensive-stage"],"trials":["slotman-pci-es-sclc","takahashi-pci"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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"]},"route":"/technologies/prophylactic-cranial-irradiation/","neighbours":{"cancer":[{"id":"extensive-stage-sclc","kind":"cancer","name":"Extensive-stage small-cell lung cancer","route":"/cancers/extensive-stage-sclc/"},{"id":"all-paediatric-high-risk","kind":"cancer","name":"High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL)","route":"/cancers/all-paediatric-high-risk/"},{"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/"}],"section":[{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"}],"technology":[{"id":"gamma-knife","kind":"technology","name":"Gamma Knife","route":"/technologies/gamma-knife/"},{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"mri","kind":"technology","name":"MRI","route":"/technologies/mri/"},{"id":"sbrt","kind":"technology","name":"SBRT / SABR (stereotactic radiotherapy)","route":"/technologies/sbrt/"}],"term":[{"id":"limited-extensive-stage","kind":"term","name":"Limited-stage vs extensive-stage (small-cell lung cancer)","route":"/terms/limited-extensive-stage/"},{"id":"pci-term","kind":"term","name":"Prophylactic cranial irradiation (PCI)","route":"/terms/pci-term/"},{"id":"wbrt","kind":"term","name":"Whole-brain radiotherapy (WBRT)","route":"/terms/wbrt/"}],"trial":[{"id":"adriatic","kind":"trial","name":"ADRIATIC","route":"/trials/adriatic/"},{"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/"}],"idea":[{"id":"idea-lung-brain-metastasis-prevention-as-a-primary-endpoint","kind":"idea","name":"Measure brain metastasis prevention as a primary endpoint, not as a secondary one","route":"/ideas/idea-lung-brain-metastasis-prevention-as-a-primary-endpoint/"},{"id":"idea-mri-surveillance-replaces-pci","kind":"idea","name":"MRI surveillance replaces prophylactic cranial irradiation in SCLC","route":"/ideas/idea-mri-surveillance-replaces-pci/"}],"paper":[{"id":"paper-adriatic-nejm-2024","kind":"paper","name":"ADRIATIC: durvalumab after chemoradiotherapy for limited-stage small-cell lung cancer","route":"/key-papers/paper-adriatic-nejm-2024/"},{"id":"paper-paz-ares-caspian-durvalumab-es-sclc-lancet-2019","kind":"paper","name":"Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN)","route":"/key-papers/paper-paz-ares-caspian-durvalumab-es-sclc-lancet-2019/"},{"id":"paper-auperin-prophylactic-cranial-irradiation-sclc-nejm-1999","kind":"paper","name":"Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission","route":"/key-papers/paper-auperin-prophylactic-cranial-irradiation-sclc-nejm-1999/"}],"bottleneck":[{"id":"b-brain-delivery","kind":"bottleneck","name":"The brain: barrier and sanctuary","route":"/bottlenecks/b-brain-delivery/"}],"pathway":[{"id":"blood-brain-barrier-metastasis","kind":"pathway","name":"The blood-brain barrier & brain metastasis","route":"/pathways/blood-brain-barrier-metastasis/"}],"roadmap":[{"id":"radiation-roadmap","kind":"roadmap","name":"Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH","route":"/roadmaps/radiation-roadmap/"}]}}