Panelists discuss how comprehensive biomarker testing is essential for all patients with early-stage non–small cell lung cancer (NSCLC), with thoracic specialists emphasizing the importance of testing primary tumor samples and lymph nodes to identify actionable mutations that guide treatment decisions and inform patients about their therapeutic journey, particularly as targeted therapies and immunotherapies continue to advance in early-stage and locally advanced disease settings.

Panelists discuss how surgeon-led ultrasound-guided biopsies can expedite care timelines and overcome barriers to guideline-concordant biomarker testing that still affects one-third of eligible patients.

Panelists discuss how to manage the waiting period for biomarker results while balancing urgency in curable patients, emphasizing the importance of tissue-based testing over liquid biopsies in early-stage disease.

Panelists discuss how multidisciplinary coordination and early communication between surgical, pulmonary, and oncology teams ensures adequate tissue procurement for molecular testing from the initial biopsy.

Panelists discuss how resectability determination remains surgeon-dependent and institution-specific, requiring careful consideration of both technical feasibility (“can you”) and appropriateness (“should you”) for individual patients.

Panelists discuss how to pivot treatment plans when patients cannot proceed to surgery after induction therapy, emphasizing the importance of determining resectability up front and having multidisciplinary contingency plans.

Panelists discuss how most patients with early-stage disease who would benefit from systemic therapy should receive neoadjuvant treatment, with direct surgery reserved mainly for those with medical contraindications to immunotherapy.

Panelists discuss how treatment selection for early-stage disease depends on lymph node metastasis risk, with SBRT considered for very low-risk peripheral tumors and surgery preferred when staging information is needed.

Panelists discuss how concurrent chemoradiation remains standard, when possible, with sequential approaches for frail patients, and consolidation immunotherapy recommended regardless of the initial radiation approach.

Panelists discuss how multistation N2 disease is no longer an absolute contraindication to surgery, with treatment decisions based on biology rather than just nodal station number, though bulky vs invasive disease characteristics matter.

Panelists discuss how the rapid integration of immunotherapy and targeted therapies into perioperative care requires constant practice updates and individualized decision-making based on pathologic response and patient characteristics.

Panelists discuss how restaging practices vary widely, with most favoring CT imaging over routine invasive restaging, while debating the optimal number of induction cycles (3 vs 4) and timing of surveillance.

Panelists discuss how to carefully manage radiation therapy after induction immunotherapy in surgically ineligible patients, treating only visible disease and considering additional immunotherapy based on patient tolerance and response.

Panelists discuss how stage IIIB treatment decisions require individual assessment, with surgery considered for selected T3/T4 tumors but not routinely for N3 disease, while postoperative radiation is generally not recommended.

Panelists discuss how financial toxicity and cost-effectiveness analyses highlight the importance of appropriate patient selection for perioperative immunotherapy, while emphasizing that multidisciplinary care and patient involvement remain essential for optimal outcomes.