Multidisciplinary questions in thoracic oncology : The team experience Management of stages I & II NSCLC

The incidence of stage I and II non-small cell lung cancer (NSCLC) is likely to increase with the aging population and introduction of screening for high-risk individuals. Optimal management requires multidisciplinary collaboration. Local treatments include surgery and radiotherapy and these are currently combined with (neo)adjuvant chemotherapy in specific cases to improve long-term outcome. Targeted therapies and immunotherapy also may become an important therapeutic modality in this patient group. For resectable disease in patients with low cardiopulmonary risk complete surgical resection with lobectomy remains the gold standard. Minimally invasive techniques (MIT), conservative and sublobar resections are suitable for a subset of patients. Data are emerging that radiotherapy, especially stereotactic body radiation therapy, is a valid alternative in compromised patients who are high-risk candidates for surgery. Whether this is also true for good surgical candidates remains to be evaluated in randomised trials. In specific subgroups adjuvant chemotherapy has been shown to prolong survival; however, patient selection remains important. Neoadjuvant chemotherapy may yield similar results as adjuvant chemotherapy. The role of targeted therapies and immunotherapy in early stage NSCLC has not yet been determined and results of randomised trials are awaited.