How do you decide whether to offer PCI in patients with ES-SCLC who cannot get brain MRIs?

The Slotman study that showed a benefit for PCI did not have CNS staging (CT or MRI) done routinely for asymptomatic patients, so I don’t think of it as PCI. Since 30% or so patients with SCLC have brain metastases, this version of “PCI” is just treating brain mets. That’s probably what produced the...

Normally for my ES-SCLC patients, I do discuss the Slotman trial, but generally recommend against PCI based on the Takahashi trial if they can get regular MRIs.

However, I believe there is a difference in detection rates between CT and MRI, including evaluation of how big for something to actually sh...