This is an important question with implications for both overall survival (OS) and quality of life (QOL) where level-1 evidence is currently lacking. It is also the subject of an ongoing phase 3 trial (SWOG S1827/Maverick) that randomizes patients with limited-stage (LS) and extensive-stage (ES) SCL...

The Meta-analyses reported a survival advantage in LD SCLC. About 10% present with isolated BM, and 60% fail in the brain without PCI. Decreased cognition was reported by 24 months by Arriagada. Some have noted decreased cognition post WBRT in both NSCLC. There has been advocates for obser...

I have no problem discussing PCI in terms of risks and benefits. There are clearly cognitive side effects and the extent for any given patient are impossible to predict. I give patients the data on number need to treat to get one life saved (20) at 3 years and discuss the benefit of preventing morbi...

For patients with stage I disease, I have offered observation as well as PCI. Xu J et al (J Thorac Oncol 2017;12(2):347-53) reported that for surgically resected stage I disease, there was no survival advantage and no associated reduction in the development of brain metastases (13.6% vs 10.5%). Howe...

The standard of care remains PCI and I discuss risks and benefits with patients, who can certainly make an informed decision to decline PCI since the tradeoff of a likely reduction in brain mets/neurologic death vs. neurocognitive effects can be viewed very differently by different patients. I do th...

Yes, in selected patients with more limited disease who may be at higher risk for morbidity. (Age, pre-existing dementia)

I accept no PCI for over 70, and stage I S or SBRT patients. Randomize ED. I’m not convinced H-Sparing works. Brain toxicity occurs, in my reading, not common, and measures used are not convincing. The best way to get poor cognition is allowing a met. Not convinced that SRS salvages. Prove ben...