SCLC — SCE Medical Oncology MCQ

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ModerateLung CancerSCLCSCE Medical Oncology

A 63-year-old woman with limited-stage SCLC (T2 N2 M0) completes 4 cycles of cisplatin-etoposide with concurrent thoracic radiotherapy and achieves a complete response. What additional treatment should be offered?

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Correct answer: C — Prophylactic cranial irradiation (PCI)

Prophylactic cranial irradiation (PCI) is the established standard for limited-stage SCLC patients who achieve complete response to concurrent chemoradiotherapy. Following the landmark UKCCCR/EORTC trial and current SEOM-GECP guidelines, PCI is indicated to reduce brain metastasis risk and improve overall survival; approximately 45% of CR patients develop brain metastases without PCI. Recent MRI-era analysis confirms efficacy in modern practice. While consolidation immunotherapy (e.g., durvalumab in ADRIATIC) is an emerging addition to treatment paradigms, PCI remains the established next step. Thoracic boost is not indicated after achieving CR. Topotecan and atezolizumab maintenance are not standard in this setting. Surveillance alone omits the established brain metastasis prevention strategy.

Reference: SEOM-GECP Clinical guidelines for diagnosis, treatment and follow-up of small-cell lung cancer (2022). PCI recommended for LS-SCLC without progression after concurrent chemoradiotherapy. Supported by EORTC/UKCCCR RCT (1997) and MRI-era confirmation studies (2022). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425483/