Is it reasonable to offer observation with MRI rather than immediate PCI for patients with limited stage SCLC?

The Meta-analyses reported a survival advantage in LD SCLC. About 10% present with isolated BM, and 60% fail in the brain without PCI. Decreased cognition was reported by 24 months by Arriagada.

Some have noted decreased cognition post WBRT in both NSCLC. There has been advocates for observation ...

I have no problem discussing PCI in terms of risks and benefits. There are clearly cognitive side effects and the extent for any given patient are impossible to predict. I give patients the data on number need to treat to get one life saved (20) at 3 years and discuss the benefit of preventing morbi...

For patients with stage I disease, I have offered observation as well as PCI. Xu et al., PMID 27725211 reported that for surgically resected stage I disease, there was no survival advantage and no associated reduction in the development of brain metastases (13.6% vs 10.5%). However, for stage II, PC...

Yes, MRI surveillance alone without PCI is a reasonable option for patients with LS-SCLC.

The prospective data supporting delivery of PCI in LS-SCLC are primarily from the pre-MRI era. The landmark meta-analysis by Aupérin and colleagues published in 1999 included individual patient data from 987 pat...

The standard of care remains PCI, and I discuss risks and benefits with patients, who can certainly make an informed decision to decline PCI since the tradeoff of a likely reduction in brain mets/neurologic death vs. neurocognitive effects can be viewed very differently by different patients. I do t...

I accept no PCI for over 70, and stage I S or SBRT patients. Randomize ED. I’m not convinced H-Sparing works. Brain toxicity occurs, in my reading, not common, and measures used are not convincing. The best way to get poor cognition is allowing a met. Not convinced that SRS salvages. Prove benefit i...

Yes, in selected patients with more limited disease who may be at higher risk for morbidity (age, pre-existing dementia).

The SWOG MAVERICK included patients with limited-stage SCLC, so it is reasonable to use MRI brain scans for surveillance rather than immediate PCI for SCLC to help preserve patients' neurocognition. We do need to wait for longer follow-up so that we can see the overall survival rate outcomes for bot...