[Expert consensus on diagnosis and treatment of lung cancer complicated with interstitial lung disease]

The prevalence and incidence of lung cancer combined with interstitial lung disease is high. The comorbidity of lung cancer and interstitial lung disease has attracted extensive attention in recent years. If patients with ILD are definitely diagnosed, high-resolution thin-layer lung CT should be performed every year to detect the comorbid patients with lung cancer as soon as possible. On the premise of stable ILD condition, the most suitable anti-tumor treatment should be selected according to the pathological type, clinical stage, physical status, driver gene status, immune status, and comprehensive efficacy and safety considerations of patients with lung cancer. In patients with early lung cancer complicated with ILD, perioperative risk assessment should be fully carried out, and the surgical method and resection scope should be determined through MDT discussion. The incidence of radiotherapy related lung injury in lung cancer patients with ILD is high. It is suggested that multidisciplinary discussion should be conducted to select the appropriate radiotherapy regimen and dose. Chemotherapy is an effective treatment for patients with lung cancer complicated with ILD. It is recommended to select the appropriate chemotherapy according to the pathological type, clinical stage and PS score of lung cancer on the premise of stable ILD. Patients with lung cancer complicated with ILD have a low mutation rate of driver genes, and there is a risk of TKI related ILD. For lc-ild patients with positive driver gene mutations, targeted drugs with low pulmonary toxicity should be selected as cautiously as possible. Patients with lung cancer and ILD can benefit from immunotherapy. Patients with mild ILD and lung cancer can choose immunotherapy. Patients with moderate severe ILD and lung cancer should weigh the advantages and disadvantages and use immunotherapy cautiously. At the same time, the occurrence of adverse reactions of immunotherapy should be closely monitored. In the future, large-scale prospective randomized controlled clinical trials need to be carried out to explore the most suitable treatment scheme for lung cancer complicated with ILD, and improve the survival and prognosis of patients with comorbid diseases.