Lung Cancer Treatment: What Approaches Are Used as of 2026?

Lung cancer treatment is determined by stage, histologic type, and biomarker test results, combining surgery, radiation therapy, targeted therapy, immunotherapy, and chemotherapy. No single approach fits every patient — stage 1-2 centers on surgery, stage 3 involves combined-modality treatment, and stage 4 focuses mainly on systemic therapy.

Key Summary

• Korea's 5-year relative survival rate for lung cancer is 42.5%, up 30 percentage points from 1993-1995 (National Cancer Registration Statistics 2019-2023, National Cancer Center Korea).
• For stage 1-2, surgery such as thoracoscopic or robotic lobectomy is the standard; if surgery is not feasible, stereotactic body radiation therapy (SBRT) can be completed in a short course.
• Stage 3 combines surgery, chemotherapy, and radiation. When surgery is possible, neoadjuvant chemotherapy plus immunotherapy followed by surgery is increasingly becoming the standard approach.
• For stage 4, patients with biomarkers such as EGFR or ALK typically start with oral targeted therapy; those without such markers begin with immune checkpoint inhibitors or chemotherapy combinations.
• East Asian patients tend to have a relatively higher rate of EGFR mutations, so targeted therapy is offered as an option more often than in Western populations.

How Is Staging Determined, and Why Does Biomarker Testing Matter?

• Staging begins with a chest CT to identify a suspicious lesion, followed by a biopsy for confirmation, with PET-CT and brain MRI used to check for metastasis. Non-small cell lung cancer is classified into stages 1-4 using the TNM system, and whether mediastinal lymph nodes are involved is the key factor determining operability.
• For advanced or metastatic non-small cell lung cancer, genetic alterations such as EGFR, ALK, ROS1, BRAF, KRAS, MET, RET, and NTRK, along with PD-L1 expression, must be checked to select appropriate drugs. Next-generation sequencing (NGS), which examines multiple genes at once, is commonly used.
• Without biomarker results, targeted therapy cannot be selected, so along with staging, whether biomarker testing has been done is a core piece of information in remote review (pre-arrival review).

What Is the Standard Treatment Flow by Stage?

• Step 1 (Stage 1-2) — Thoracoscopic or robotic lobectomy with lymph node dissection is standard; depending on surgical pathology results, adjuvant chemotherapy or targeted/immunotherapy may follow. If surgery is not feasible, stereotactic body radiation therapy is used instead.
• Step 2 (Stage 3) — If operable, neoadjuvant chemotherapy plus immunotherapy is given to shrink the tumor before surgery. If inoperable, concurrent chemoradiotherapy is given, followed by immunotherapy.
• Step 3 (Stage 4) — Systemic therapy is central. Patients with a targetable mutation start with oral targeted agents; those without start with immune checkpoint inhibitors alone or combined with chemotherapy, based on PD-L1 expression and histologic type. If brain or bone metastases are present, radiation therapy is added to those sites.
• Small cell lung cancer is treated primarily with chemotherapy and radiation therapy, plus immunotherapy. If disease is confined to one side of the chest, concurrent chemoradiotherapy is given, and prophylactic cranial radiation may be considered if the response is good.

FAQ — Is Treatment More Difficult If There Is Brain Metastasis?

Some targeted therapies penetrate the brain effectively, and stereotactic radiation therapy can be applied separately to metastatic sites. Which treatment to pursue first is decided based on the condition of the lesions and overall health status, and the sequence can be confirmed at the written opinion stage.

FAQ — Can I Take Oral Targeted Therapy Drugs Back to My Home Country?

In many cases, patients can take home a prescribed supply for a certain period, but import regulations and quantity limits vary by country, so advance confirmation is needed. Immunotherapy eligibility is determined by PD-L1 expression, histologic type, overall health status, and presence of autoimmune disease, so it is not suitable for every patient.

Sources and Notes

This article was written based on National Cancer Registration Statistics 2019-2023 (Central Cancer Registry, National Cancer Center Korea), SEER 2016-2022, the National Cancer Information Center, and NCCN patient guideline materials. This content is intended for general medical information purposes, and actual diagnosis, treatment methods, and outcomes may vary depending on individual circumstances. Accurate diagnosis and treatment should always be determined through consultation with medical professionals.