Would you use a hippocampal sparing technique when treating with PCI for a limited stage small cell lung cancer?

This is an important question where the evidence is evolving, and some key trials remain ongoing. Because the data remains in flux, in the ongoing phase 3 SWOG S1827/Maverick trial of MRI surveillance +/- prophylactic cranial irradiation (PCI) for LS and ES-SCLC, where I serve as the PI, hippocampal avoidance (HA)-PCI is optional at patient/physician discretion.

The strongest evidence for HA, in general, comes from the NRG CC001 trial, which randomized 518 patients with brain metastases from mixe...

The potential cognitive preservation benefits of hippocampal sparing remain the subject of ongoing phase III trials. In the setting of PCI for small cell lung cancer, NRG CC003 is a phase III trial of PCI with or without hippocampal avoidance; at our institution, eligible patients are enrolled on this trial. The risk of hippocampal avoidance during PCI for small cell lung cancer is the risk of relapse in the hippocampal avoidance region. This risk has been estimated to be ~5%, but CC003 is power...