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Lung: Extensive-stage SCLC - PCI

Free question published 13 September 2026

RespiratoryExtensive-stage SCLC - PCI

A 67-year-old woman with extensive-stage small-cell lung cancer has had a good response to first-line platinum-etoposide chemotherapy, with no brain metastases on staging MRI and WHO performance status 1. The MDT discusses prophylactic cranial irradiation. Which statement best reflects NICE NG122 guidance on prophylactic cranial irradiation in this extensive-stage setting?

  1. AConsider prophylactic cranial irradiation if the disease has responded to first-line treatment and performance status is 0 to 2
  2. BOffer prophylactic cranial irradiation only if brain metastases are already present
  3. CProphylactic cranial irradiation should replace systemic chemotherapy in extensive-stage disease
  4. DOffer prophylactic cranial irradiation to all extensive-stage patients regardless of treatment response
  5. EProphylactic cranial irradiation is contraindicated in all extensive-stage disease

Why A is correct

NICE NG122 advises that prophylactic cranial irradiation should be considered for people with extensive-stage SCLC and WHO performance status 0 to 2 if their disease has responded to first-line treatment. The wording is consider (a weaker recommendation than the offer used for limited-stage disease), reflecting the more contested evidence in the MRI surveillance era.

And why the others are not

  • BPCI is prophylactic by definition, given when there are no detectable brain metastases; established metastases require therapeutic, not prophylactic, irradiation.
  • CPCI is an adjunct after systemic chemotherapy, not a replacement for it.
  • DPCI is not offered to all extensive-stage patients indiscriminately; it is considered only in responders with adequate performance status.
  • EPCI is not contraindicated in extensive-stage disease; it is a considered option in responders.

Source NICE NG122 - Lung cancer: diagnosis and management — National Institute for Health and Care Excellence. Lung cancer: diagnosis and management. NICE guideline NG122. Published 28 March 2019, last updated 08 March 2024.

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