The evidence supporting this protocol is provided by a phase III multicentre international randomised trialr involving 286 patients comparing PCI post chemotherapy with no PCI in patients with extensive small cell lung cancer. Between 2001 and 2006, 143 patients were randomised to receive PCI and 143 patients were randomised to receive PCI after initial chemotherapy. The primary end point was symptomatic brain metastases and secondary end points were survival, toxicity and costs.
At one year the symptomatic brain metastases and overall survival were 40.4% and 13.3% respectively in the no PCI group vs 14.6% and 27.1% in PCI group. In the PCI group, brain metastases HR was 0.27 (95% CI, 0.16-0.44; p<0.001).
Preliminary results from a Japanese RCT found no improvement in overall survival in patients who had MRI to confirm absence of brain metastases prior to PCI (NCCN Clinical Practice Guidelines, Small Cell Lung Cancer, Version 1.2016, p.17).r