Early-Stage Non-Small Cell Lung Cancer: Diagnostic Challenges and Therapeutic Innovations

Dear Colleagues,

Early-stage non-small cell lung cancer (NSCLC) presents persistent diagnostic complexity despite advances in imaging and screening. Low-dose computed tomography (LDCT) has enhanced detection rates, yet differentiating indolent lesions from aggressive tumors remains challenging. Radiologic features alone are often insufficient, necessitating the integration of PET-CT, image-guided biopsy, and, increasingly, liquid biopsy and molecular profiling for accurate characterization.

Therapeutically, the landscape has evolved rapidly. Lobectomy via minimally invasive approaches remains the standard for operable patients, while stereotactic ablative radiotherapy (SABR) provides excellent local control (>90%) in those deemed medically inoperable. Recent data from trials such as ADAURA and IMpower010 support the incorporation of adjuvant targeted therapy (e.g., Osimertinib in EGFR-mutant disease) and immune checkpoint inhibitors, respectively, even in early-stage settings.

Precision oncology is now essential in the planning of treatment, with the integration of genomic and immunologic biomarkers informing both prognostication and therapeutic selection. Current clinical trials are aiming to refine neoadjuvant and adjuvant strategies, with ctDNA being employed to detect residual disease and stratify the risk of recurrence.

As our understanding of this disease is enhanced, early-stage NSCLC is shifting from a surgically focused paradigm to a multidisciplinary, biomarker-driven model of care.

Dr. Efimia Boutsikou
Dr. Georgia F. Hardavella
Dr. Kelly Domvri
Guest Editors

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