Brain MRI surveillance without prophylactic cranial irradiation improves cognitive outcomes in small cell lung cancer
In the SWOG S1827 MAVERICK Phase III randomized trial, patients with small-cell lung cancer (SCLC) who underwent regular brain MRI surveillance without prophylactic cranial irradiation (PCI) had significantly better cognitive failure-free survival (the primary endpoint of the trial), without an apparent difference in overall survival, according to results presented at the Presidential Symposium…
A recent phase 3 trial, SWOG S1827 MAVERICK, has shown that MRI surveillance alone can be as effective as MRI surveillance plus prophylactic cranial irradiation (PCI) in preventing cognitive decline in patients with small-cell lung cancer (SCLC). The international trial enrolled 304 patients from January 2020 to December 2025 and found that MRI surveillance alone significantly improved cognitive failure-free survival compared to MRI surveillance plus PCI (40% reduction in risk).
The benefit was consistent across limited-stage and extensive-stage SCLC patients, regardless of immunotherapy use. Over a median follow-up of 22 months, brain metastasis-free survival was not significantly different between the two groups. Serious treatment-related adverse events were less frequent with MRI surveillance alone, with only 0.8% of patients experiencing Grade 3-5 adverse events compared to 7.9% in the MRI plus PCI group.
Dr. Chad Rusthoven, presenting the findings at the IASLC 2026 World Conference on Lung Cancer, stated that these results support MRI surveillance alone as the standard of care for SCLC patients.
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