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SCLC — SCE Medical Oncology MCQ

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HardLung CancerSCLCSCE Medical Oncology

A fit 70-year-old with extensive-stage SCLC has responded to platinum-etoposide-immunotherapy. Baseline and post-treatment brain MRI show no metastases. How should prophylactic cranial irradiation be discussed?

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Correct answer: B — Discuss PCI versus structured MRI surveillance; survival benefit remains uncertain with modern imaging

Explanation lettering: D = shown as C · C = shown as D

B is correct. In extensive-stage SCLC without brain metastases on MRI, PCI reduces subsequent brain-metastasis risk, but the overall-survival advantage is uncertain when regular MRI surveillance and salvage treatment are available. NICE has retained this as a research question rather than a universal mandate, so age, cognition, comorbidity, response, access to reliable MRI follow-up and patient priorities matter. PCI is not restricted to complete responders in all evidence, and it does not replace maintenance immunotherapy. By contrast, NICE gives a defined 25 Gy in 10 fractions recommendation for suitable limited-stage disease that has not progressed.

Reference: NICE NG122 research recommendation on PCI in extensive-stage SCLC: https://www.nice.org.uk/about/what-we-do/research-and-development/research-recommendations/NG122/4