How do you incorporate PCI into your management of patients with extensive stage SCLC?

Given that prophylactic cranial irradiation (PCI) has been shown to decrease the incidence of symptomatic brain metastases in patients with extensive stage small cell lung cancer (ES-SCLC), but has an uncertain impact on overall survival in the conflicting EORTC and Japanese trials, do you routinely recommend it?

Answer from: Radiation Oncologist at Academic Institution

The role of prophylactic cranial irradiation (PCI) in the modern era of brain MRI surveillance has been called into question and is the topic of the ongoing phase 3 SWOG S1827/Maverick trial of MRI surveillance +/- PCI (or hippocampal avoidance [HA]-PCI) for LS and ES-SCLC, where I serve as the prin...

Comments

Medical Oncologist at UCLA Health
Great answer. Thank you

Answer from: Radiation Oncologist at Academic Institution

I must admit, that I was never a fan of PCI in the extensive SCLC setting. With the publication of the Japanese study, I am definitely not strongly recommending PCI. I think it is good to see the patient so that we can discuss both PCI and thoracic consolidation, but I have been doing more thoracic ...

Answer from: Radiation Oncologist at Community Practice

We individualize based on the extent of response and the extent of extrathoracic disease at presentation and after chemotherapy. The fact that no other intervention in the last 20 yrs has changed survival for extensive stage SCLC except for the EORTC study, despite it's design flaws (survival double...

Answer from: Radiation Oncologist at Community Practice

I offer in cases of CR to chemo.

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How do you incorporate PCI into your management of patients with extensive stage SCLC?

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