The Headline: Survival free from cognitive failure is improved with MRI surveillance versus PCI for patients with SCLC without brain mets.
The Study: The international phase 3 MAVERICK trial randomized 304 patients with small cell lung cancer (SCLC) without brain metastasis on intial staging MRI or post-initial therapy MRI to +/- prophylactic cranial irradiation (PCI). Two-thirds were limited stage and one-third extensive stage. PCI was 25 Gy in 10 fractions, and hippocampal-avoidance plans were utilized at physician discretion (77%). Everyone was surveyed with brain MRIs q3 for the first year and q6 months for the second. MRI surveillance without PCI significantly improved the primary endpoint of cognitive failure-free survival (HR 0.60). Cognitive failure was defined as a statistically meaningful decline on anyone neurocognitive test so failure-free rates at 6 months were low: 38% without versus 17% with PCI. As expected, incidence of brain metastases was higher in the no PCI arm (HR 0.62), and preliminary overall survival appeared similar.
TBL: This strengthens the case for MRI surveillance rather than routine PCI for patients with SCLC without brain mets when reliable MRI follow-up is available. | Rusthoven, ASTRO 2026
The Study: The international phase 3 MAVERICK trial randomized 304 patients with small cell lung cancer (SCLC) without brain metastasis on intial staging MRI or post-initial therapy MRI to +/- prophylactic cranial irradiation (PCI). Two-thirds were limited stage and one-third extensive stage. PCI was 25 Gy in 10 fractions, and hippocampal-avoidance plans were utilized at physician discretion (77%). Everyone was surveyed with brain MRIs q3 for the first year and q6 months for the second. MRI surveillance without PCI significantly improved the primary endpoint of cognitive failure-free survival (HR 0.60). Cognitive failure was defined as a statistically meaningful decline on anyone neurocognitive test so failure-free rates at 6 months were low: 38% without versus 17% with PCI. As expected, incidence of brain metastases was higher in the no PCI arm (HR 0.62), and preliminary overall survival appeared similar.
TBL: This strengthens the case for MRI surveillance rather than routine PCI for patients with SCLC without brain mets when reliable MRI follow-up is available. | Rusthoven, ASTRO 2026