Treatment redirection from cure to palliation, then cure again? A cautious, but urgent matter

In general, advanced lung cancers that have been either diagnosed initially as systemic metastatic disease or recurrent after curative-intended surgical resection are regarded as palliative conditions with low probabilities of long-term survival. However, post-recurrence survival (PRS) for patients has gained recent attention, because encouraging new treatments, such as target-directed therapies and immune checkpoint inhibitors, have provided better long-term survival and quality of life in selected patients with recurrent or metastatic diseases (1-3). There have been several studies of PRS after curative resection in patients with early stage lung cancer. A series of studies from Taiwan were examples, which claimed that both complete surgical resection for local recurrent disease and systemic treatment for distant failure significantly prolong PRS (4,5). However, in these investigations, the cumulative probability of PRS was less than 10%, regardless of the recurrence pattern, and thus the radical local control has generally not been recommended, except for very uncommon cases