Can Brain MRI Surveillance Alone Be Advantageous in Monitoring Cognition for Patients with SCLC?

New research suggests that brain MRI surveillance alone may facilitate significantly improved cognition preservation in contrast to the combination of brain MRI and prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC).

For the randomized phase III study, which was recently presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting, researchers reviewed data for 304 patients who received initial treatment for SCLC. The study authors noted that 68 percent of the cohort had limited-stage (LS) SCLC and 32 percent had extensive-stage (ES) SCLC. Cognitive testing of the cohort included the Hopkins Verbal Learning Test-Revised, Controlled Oral Word Association, and Trail Making Test, according to the researchers.

Noting a median follow-up of 22 months for living patients in the cohort, the study authors noted a 40 percent improvement in cognitive failure-free survival (CFFS) with brain MRI surveillance alone.

Brain MRI alone was also associated with improvements in the Patient-Reported Outcomes Measurement Information System (PROMIS) at quarterly assessments in the first year and biannual evaluation in the second year of the study. Researchers noted that those who had brain MRI surveillance alone had overall quality-of-life (QOL) improvements at 90 and 180 days with the Linear Analogue Self-Assessment (LASA) as well.

“Compared to MRI+PCI, MRI alone is associated with superior CFFS, reduced cognitive failure, and improvements in longitudinal QOL outcomes,” noted study co-author Paul Brown, MD, the Wilmeth Professor of Radiation Oncology at the Mayo Clinic in Rochester, Minn., and colleagues.

Preliminary data based on 128 deaths within the cohort demonstrated no significant difference in overall survival (OS) between brain MRI surveillance alone vs. the combination of brain MRI and PCI, according to the researchers.

“These results support MRI surveillance alone as the standard of care for (patients) with SCLC,” added Brown and colleagues.

Reference

1. Rusthoven CG, Redman M, Brown PD, et al. LBA03 – SWOG S1827/Maverick: a randomized phase III trial of brain MRI surveillance with and without prophylactic cranial irradiation (PCI) for small-cell lung cancer (SCLC). Presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting, September 26-September 30, 2026, Boston. Available at: https://amportal.astro.org/sessions/ct-01-22948/swog-s1827-maverick-a-randomized-phase-iii-trial-of-brain-mri-surveillance-with-and-without-p-114268.