ideasIdea
MRI surveillance replaces prophylactic cranial irradiation in SCLC
Instead of irradiating every patient's brain to prevent metastases, scan regularly and treat the few who develop them with focused radiation.
Modern MRI and stereotactic radiosurgery may make whole-brain PCI unnecessary. The Japanese extensive-stage trial supports this; the SWOG S1827 MAVERICK trial is the definitive test.
Hypothesis
MRI surveillance every 3 months with salvage SRS is non-inferior to PCI for overall survival and superior for cognition.
Rationale
PCI's benefit was shown before routine brain MRI; many patients irradiated never develop brain disease.
What would test it
SWOG S1827 (MAVERICK), randomised PCI vs MRI surveillance, OS primary endpoint.
Maturity
being tested at scale