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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.
Whole-brain radiotherapy to sterilise micrometastases before they become symptomatic; MRI surveillance instead detects and treats them early with stereotactic radiosurgery.
Patients with limited-stage small-cell lung cancer who complete chemoradiotherapy without progression should now be offered up to two years of durvalumab consolidation, which extends life by almost two years on average. This is the first survival improvement for limited-stage disease since twice-daily radiotherapy and prophylactic cranial irradiation, and small-cell lung cancer is no longer a disease where immunotherapy gives only marginal gains.
Immunotherapy is now part of first-line treatment for extensive-stage small-cell lung cancer everywhere, on the strength of a gain measured in weeks. The size of that gain is the reason small-cell lung cancer remains the clearest unmet need in thoracic oncology.
Treating the brain before the cancer gets there works in small-cell lung cancer, and it is the proof of principle behind every later attempt to prevent rather than treat brain metastases.
Query for this technology: (TITLE:"Prophylactic cranial irradiation vs MRI surveillance" OR ABSTRACT:"Prophylactic cranial irradiation vs MRI surveillance") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Prophylactic cranial irradiation vs MRI surveillance, not a curated reading list.
Shares EORTC 08993 (Slotman): prophylactic cranial irradiation in extensive-stage small-cell lung cancer, Takahashi trial: prophylactic cranial irradiation with MRI surveillance in extensive-stage small-cell lung cancer, Limited-stage small-cell lung cancer, Extensive-stage small-cell lung cancer.
Shares Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission, ADRIATIC: durvalumab after chemoradiotherapy for limited-stage small-cell lung cancer, Limited-stage small-cell lung cancer, Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH.
Shares Whole-brain radiotherapy (WBRT), Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission, Measure brain metastasis prevention as a primary endpoint, not as a secondary one, Gamma Knife.
Shares EORTC 08993 (Slotman): prophylactic cranial irradiation in extensive-stage small-cell lung cancer, Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission, Lung cancer (all types).
Shares MRI surveillance replaces prophylactic cranial irradiation in SCLC, Takahashi trial: prophylactic cranial irradiation with MRI surveillance in extensive-stage small-cell lung cancer.
Shares ADRIATIC, ADRIATIC: durvalumab after chemoradiotherapy for limited-stage small-cell lung cancer, Small-cell lung cancer, IMRT / IGRT (modern external beam).
Shares EORTC 08993 (Slotman): prophylactic cranial irradiation in extensive-stage small-cell lung cancer, Extensive-stage small-cell lung cancer, Lung cancer (all types), IMRT / IGRT (modern external beam).
Shares Limited-stage vs extensive-stage (small-cell lung cancer), Limited-stage small-cell lung cancer, Extensive-stage small-cell lung cancer, Small-cell lung cancer.