Table 4.

Proposed treatment for patients with NSCLC and ILDs based on refs. [14,52,171,172]. Decisions to be taken by the oncology board, considering the patient’s wishes, comorbidities, NSCLC stadium, and ILD stadium. Oncologic outcomes and preservation of lung function to be considered. Close monitoring for AE-ILD and pneumonitis required.

Stage of NSCLC	Treatment Options for NSCLC with ILD
Stage I	-Surgical resection (lobectomy or segmentectomy): for patients with stable and well-controlled ILD, with mild to moderately impaired lung function -Stereotactic body radiation therapy (SBRT): alternative to surgery for patients who are not surgical candidates due to their ILD, due to poor lung function or comorbidities. Option in a minority of very carefully selected patients due to the possible detrimental risk of pneumonitis -Percutaneous image-guided ablation to be considered in patients with poor lung function and small tumors
Stage II	-Surgical resection: for patients with stable and well-controlled ILD, with mild to medium impaired lung function -SBRT: For patients unsuitable for surgery due to ILD, SBRT may be considered. Option in a minority of very carefully selected patients due to the possible detrimental risk of pneumonitis
Stage III	-Radio chemotherapy: standard of treatment for locally advanced NSCLC. Decision to proceed in patients with ILD to be taken in oncology board, considering the high potential risk of pulmonary toxicity. Sequential, instead of concomitant therapy may be associated with reduced risk of pulmonary toxicity. Radiation therapy may be an option in a small minority of very carefully selected patients due to the possible detrimental risk of pneumonitis -Immunotherapy: may be considered in patients with stable ILD and mild to moderately impaired lung function, as part of the treatment regimen
Stage IV	-Systemic therapy: chemotherapy, targeted therapy, immunotherapy, or a combination of the above depending on the patient’s performance status, ILD status and comorbidities -Palliative care: in advanced stages of NSCLC or end-stage ILD