Transbronchial Techniques for Lung Cancer Treatment: Where Are We Now?

Simple Summary Traditionally, local treatment of lung cancers mainly consists of three branches: surgical resection, radiotherapy, and percutaneous ablation. With the advent of new technologies such as electromagnetic navigation bronchoscopy and robotic bronchoscopy, transbronchial therapies are being developed. This gives substantial hope to high-risk patients, especially those who have had prior chest radiation exposure or frail patients who could not tolerate surgery, as they would otherwise be excluded from the currently established forms of local treatment. In addition, demand for local ablation is also rising due to an increasing incidence of multiple synchronous lung cancers arising in the same patient. In this review, we discuss state-of-the-art transbronchial techniques for lung cancer treatment. The demand for parenchyma-sparing local therapies for lung cancer is rising owing to an increasing incidence of multifocal lung cancers and patients who are unfit for surgery. With the latest evidence of the efficacy of lung cancer screening, more premalignant or early-stage lung cancers are being discovered and the paradigm has shifted from treatment to prevention. Transbronchial therapy is an important armamentarium in the local treatment of lung cancers, with microwave ablation being the most promising based on early to midterm results. Adjuncts to improve transbronchial ablation efficiency and accuracy include mobile C-arm platforms, software to correct for the CT-to-body divergence, metal-containing nanoparticles, and robotic bronchoscopy. Other forms of energy including steam vapor therapy and pulse electric field are under intensive investigation.