Striking a balance: Surveillance of non–small cell lung cancer after resection

Commentary: The value of close surveillance after lung cancer surgery: How absence of evidence is not evidence of absence

“…It did not specifically look for signs of recurrence of lung cancer, which usually include regional adenopathy and distant metastasis. 12 Heiden and colleagues 13 presented a comprehensive treatise on the current guidelines for PRIS, reviewing the evidence or lack thereof behind them. The article determines that the current recommendations of scanning every 3 to 6 months may be too aggressive and suggests that a more "balanced" protocol of once a year may be sufficient.…”

“…The article justifies this approach by the lack of effective therapy for most regional or distant recurrences and the lack of proof of any benefit from frequent surveillance. 13 Regional or distant RIPLC carries a grim prognosis, but there are more therapeutic options today than even a decade ago, including targeted therapy, immunotherapy, hypofractionated radiation, and catheter-based ablation. This makes it difficult to justify intentionally avoiding its early identification by less frequent scanning.…”

Commentary: Channeling Goldilocks

“…As "the other pandemic," lung cancer kills more humans worldwide than the other 3 leading cancers combined (breast, colorectal, and prostate). 1 Survival remains dismal, except in early stages when surgical resection is the standard of care, offering a 5-year survival up to 94% for stage I disease. 2 After surgery, however, there are inherent risks of cancer recurrence, either the recurrent initial pulmonary cancer (RIPLC) or a new primary lung cancer (NPLC).…”

“…In this Invited Expert Opinion piece, Heiden and colleagues 1 discuss the evidence for surveillance of lung cancer following resection and treatment. It is somewhat surprising that there is such low-level evidence for routine surveillance imaging and even more surprising that the rate of guideline concordance for "appropriate" surveillance in patients with resected lung cancer is a paltry 61%.…”