For some lung cancer patients, regular MRI may beat preventive brain radiation
Brain MRI surveillance alone may be a better option than prophylactic cranial irradiation for patients with small-cell lung cancer, according to phase 3 trial results presented at the International Association for the Study of Lung Cancer 2026 World Conference on Lung Cancer.
The MAVERICK trial found that patients monitored with regular brain MRI had significantly better cognitive failure-free survival than those who received irradiation in addition to MRI surveillance. The findings could shift the standard approach to preventing brain metastases in small-cell lung cancer, particularly as modern MRI allows clinicians to detect and treat brain disease earlier.
The international trial enrolled 304 patients with limited- or extensive-stage cancer who had completed initial treatment with no evidence of brain metastases on imaging. Patients were randomly assigned to MRI surveillance alone or MRI surveillance plus irradiation at a dose of 25 Gy in 10 fractions. Both groups underwent brain MRI every three months during the first year and every six months during the second year, along with cognitive testing.
After a median follow-up of 22 months among living patients, MRI surveillance alone reduced the risk of cognitive failure or death by 40% compared with MRI surveillance plus prophylactic cranial irradiation. The benefit was consistent among patients with both limited- and extensive-stage disease and regardless of immunotherapy use. The preliminary overall survival analysis showed no significant difference between the groups, though the final analysis is pending. Brain metastasis-free survival also was similar between the groups.
MRI surveillance alone also was associated with substantially fewer serious treatment-related adverse events. Grade 3–5 events occurred in 0.8% of patients receiving MRI surveillance alone compared with 7.9% of those receiving cranial irradiation; one grade 5 encephalopathy event occurred in the latter group.
For radiology, the findings highlight the growing role of serial brain MRI as an active component of small-cell lung cancer management rather than a surveillance tool alone. Regular imaging may allow patients to dodge prophylactic radiation while still being monitored closely for metastatic disease.
"These results support MRI surveillance alone as the standard of care for patients with [small-cell lung cancer],” Chad Rusthoven, MD, of the University of Colorado School of Medicine, said during a presentation on the results.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.