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Real-World Application of ctDNA-MRD in Early-Stage Lung Adenocarcinoma: Two Clinical Case Analyses​

In this case-based presentation, Dr. Sutima Luangdilok presents two early-stage lung adenocarcinoma cases that illustrate the clinical value of ctDNA-based minimal residual disease (MRD) testing in post-operative decision-making. Both patients underwent curative-intent surgery for stage I tumors with high-risk features, yet traditional imaging offered limited insight into their recurrence risk.​

Through integration of ctDNA-MRD testing, molecular relapse was identified before clinical or radiological progression, prompting the use of systemic therapies—including chemotherapy and immunotherapy—that may not have been initiated based on staging alone. These cases highlight how MRD positivity can uncover occult disease, personalize adjuvant treatment, and potentially prevent overt relapse in otherwise early-stage patients.​

The presentation also underscores critical challenges in early-stage NSCLC: distinguishing multifocal primaries from metastases, interpreting equivocal PET findings, and balancing observation with proactive intervention. By showcasing how ctDNA-MRD complements pathology and imaging, this session advances the conversation around precision surveillance and treatment tailoring in resected NSCLC.​