Bronchoscopic Ablation and Intratumoral Therapies for Lung Cancer: Expanding Local Treatment Beyond Surgical Resection

Advances in navigational bronchoscopy, robotic platforms, and intraprocedural imaging have transformed bronchoscopy from a diagnostic modality into a potential therapeutic platform for localized treatment of lung cancer. These developments are particularly relevant for patients who are medically inoperable, have limited pulmonary reserve, or require lung-sparing treatment strategies. This narrative review summarizes current evidence regarding bronchoscopic ablative technologies and intratumoral therapies for lung cancer. We discuss technological foundations including robotic bronchoscopy, electromagnetic and shape-sensing navigation, cone-beam computed tomography, augmented fluoroscopy, and radial endobronchial ultrasound. Available ablative modalities, including radiofrequency ablation, microwave ablation, cryoablation, photodynamic therapy, and pulsed electric field ablation, are reviewed alongside bronchoscopically delivered intratumoral chemotherapy, immunotherapy, and gene-based therapies. Early clinical studies demonstrate high technical success rates and favorable safety profiles for multiple bronchoscopic ablative approaches, with substantially lower rates of pleural complications compared with percutaneous techniques. Intratumoral therapies enable delivery of high local drug concentrations while minimizing systemic toxicity and may enhance antitumor immune responses through modulation of the tumor microenvironment. Emerging evidence suggests potential synergy between local ablation and immunotherapeutic strategies. However, available data remain limited by small sample sizes, heterogeneous treatment protocols, and a lack of randomized comparative studies. Bronchoscopic ablation and intratumoral therapies represent promising additions to the thoracic oncology armamentarium. Continued advances in navigation, imaging, and therapeutic delivery systems are enabling increasingly precise, minimally invasive interventions. Prospective clinical trials are needed to define optimal patient selection, procedural strategies, and integration with surgery, radiation, and systemic therapies within multidisciplinary lung cancer care.