Overview
Lung cancer is one of the most common and deadliest cancers worldwide, representing the leading cause of cancer-related mortality globally, with a substantial annual incidence across both developed and developing countries.
The overall prognosis remains poor, with a 5-year relative survival of approximately 15% in males and 20% in females in Germany. The two main histological types are:
- Non-small cell lung cancer (NSCLC) (~85%)
- Small cell lung cancer (SCLC) (~15%)
Despite advances in screening and therapy, most NSCLC cases are still diagnosed at advanced stages.
Importance of Specialized Care
Lung cancer management requires a multidisciplinary and highly specialized approach due to its biological heterogeneity and frequent advanced-stage presentation.
In Germany, optimal care is delivered through personalized, stage-adapted treatment strategies, which are central to modern oncology and form the basis of INDID Telemedicine workflows.
Accurate histological classification, molecular profiling, and precise staging are essential for treatment planning and are key determinants of outcome.
Within INDID Telemedicine, cases are coordinated with local physicians and subsequently reviewed in multidisciplinary tumor boards at certified partner centers in Germany. Diagnostic gaps (pathology or imaging) are actively identified and resolved in collaboration with international partners.
Initial Diagnostic Workup and Staging
For most international patients, full staging can be completed locally in coordination with INDID Telemedicine, without the need for immediate travel to Germany.
Baseline assessment
- Medical history and physical examination
- Family history
- Blood tests: full blood count, liver and renal function, tumor markers
Pathology
- Definitive diagnosis requires tissue biopsy
- Methods include:
- Bronchoscopy
- CT-guided needle biopsy
- Mediastinoscopy
- Sputum cytology may be used as an initial screening tool but has limited sensitivity and cannot replace biopsy.
Existing pathology reports are centrally reviewed. If necessary, tissue blocks (paraffin-embedded or frozen samples) may be reassessed in German reference pathology laboratories to ensure diagnostic accuracy and complete molecular characterization.
Imaging
- Chest X-ray (initial assessment)
- CT scan of chest (mandatory for staging)
- PET-CT (for systemic staging and metastasis detection)
- Brain MRI (recommended in advanced NSCLC and SCLC)
- Bone scan or PET-CT for skeletal metastases
High-quality DICOM imaging is essential. INDID Telemedicine coordinates repeat imaging if quality or completeness is insufficient for staging.
PET-CT availability varies by country and is highly valuable for accurate staging when accessible.
Multidisciplinary Treatment Planning
All cases are discussed in multidisciplinary tumor boards including:
- Thoracic surgeons
- Medical oncologists
- Radiation oncologists
- Radiologists
- Pulmonologists
- Molecular pathologists
Treatment selection is based on:
- Histological subtype (NSCLC vs SCLC)
- Disease stage
- Molecular profile
- Patient performance status
- Resectability and metastatic burden
Treatment Modalities
Surgery
Surgical resection is the primary curative option for early-stage NSCLC. Procedures include:
- Wedge resection
- Segmentectomy
- Lobectomy
- Pneumonectomy
Surgery is increasingly combined with neoadjuvant or adjuvant systemic therapies in multimodal treatment strategies.
Radiotherapy
Radiotherapy is used in:
- Locally advanced disease (often combined with chemotherapy)
- Postoperative adjuvant settings
- Definitive treatment in non-surgical candidates
Stereotactic body radiotherapy (SBRT) is an option for patients who are not surgical candidates due to comorbidities.
Proton beam therapy may be considered in selected cases to reduce toxicity near critical structures.
Chemotherapy
Chemotherapy is used:
- Adjuvantly after surgery
- Neoadjuvantly to downstage tumors
- In combination with radiotherapy
- In advanced or metastatic disease
Its role depends on stage, histology, and molecular profile.
Targeted Therapy
Targeted therapies are indicated in molecularly defined NSCLC subgroups, including:
- EGFR mutations
- ALK rearrangements
- ROS1 rearrangements
- RET fusions
- MET exon 14 skipping
- KRAS G12C mutations
Agents include tyrosine kinase inhibitors (TKIs) and other pathway-specific inhibitors.
Liquid biopsy (ctDNA) is increasingly used for mutation detection and resistance monitoring.
Immunotherapy
Immune checkpoint inhibitors are a standard of care in advanced NSCLC.
Pembrolizumab is a first-line standard option in patients with:
- High PD-L1 expression (≥50%)
- No contraindications such as severe autoimmune disease or organ transplantation
Other checkpoint inhibitors are used based on combination regimens and tumor profile.
Follow-Up Strategy
Due to the aggressive nature of lung cancer, structured and close follow-up is essential.
Standard follow-up schedule
- First evaluation: 2–3 months after completion of therapy
- Every 3–6 months for the first 2 years:
- Clinical assessment
- CT imaging
After 2 years: follow-up intervals may be extended based on risk
Follow-up care is coordinated via INDID Telemedicine, allowing continued monitoring without repeated travel to Germany.
Key Strength of INDID Telemedicine Approach
INDID Telemedicine integrates:
- Cross-border diagnostic completion
- Central molecular and pathological review
- Multidisciplinary tumor board decision-making in Germany
- Personalized multimodal treatment planning
- Remote longitudinal follow-up and relapse monitoring
This ensures rapid access to high-level German lung cancer expertise while reducing diagnostic delays and unnecessary international travel.
References
- Zer, A., Ahn, M. J., Barlesi, F., et al. (2025). Early and locally advanced non-small-cell lung cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology, 36(11), 1245–1262. https://doi.org/10.1016/j.annonc.2025.08.001
- Suay, G., Aparisi, F., Juan-Vidal, O. (2024). ESMO guidelines for oncogene-addicted metastatic NSCLC: personalized treatment approaches. Chinese Clinical Oncology, 13(46). https://doi.org/10.21037/cco-23-100
- ESMO–ESTRO (2026). Consensus on safety of combining radiotherapy with targeted therapies in NSCLC. ESMO Open, 11(3), 106076. https://doi.org/10.1016/j.esmoop.2026.106076
