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Lung: Prophylactic cranial irradiation

Free question published 02 September 2026

RespiratoryProphylactic cranial irradiation

A 62-year-old man with limited-stage small-cell lung cancer has completed concurrent chemoradiotherapy. Restaging imaging confirms a good partial response with no progression, and an MRI brain shows no metastases. WHO performance status is 1. What is the most appropriate next step in management?

  1. ANo prophylactic cranial irradiation; MRI surveillance only
  2. B30 Gy in 10 fractions
  3. C25 Gy in 10 fractions
  4. D20 Gy in 5 fractions
  5. E36 Gy in 18 fractions with hippocampal avoidance

Why C is correct

NICE NG122 recommends offering prophylactic cranial irradiation at a dose of 25 Gy in 10 fractions to people with limited-stage SCLC and WHO performance status 0 to 2 if their disease has not progressed on first-line treatment. This patient meets every criterion.

And why the others are not

  • ASurveillance MRI alone is not the NICE recommendation in limited-stage SCLC responders; prophylactic cranial irradiation is offered.
  • B30 Gy in 10 fractions is not the NICE-specified PCI dose; higher doses showed no benefit and more neurotoxicity.
  • D20 Gy in 5 fractions is not the recommended schedule for limited-stage SCLC PCI under NICE NG122.
  • EHippocampal-avoidance PCI at 36 Gy is not the NICE-specified standard regimen here; the recommended dose is 25 Gy in 10 fractions.

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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