Bronchoscopic treatment of thoracic malignancy

Interventional pulmonologists face unique challenges in managing thoracic malignancies, specifically malignant central airway obstruction (MCAO) and peripheral lung malignancies. In addressing MCAO management, various ablative modalities, including argon plasma coagulation and cryo-debulking, offer immediate effects, while others such as photodynamic therapy (PDT) and cryo-spray exhibit delayed efficacy. In cases where extrinsic compression limits debulking, airway stents can be considered. Typically, a combined approach is adopted by physicians to effectively address the obstruction. Ablative modalities can be strategically employed with a curative intent in the management of early -stage malignancies confined to the airway, with the most robust evidence supporting PDT. Novel modalities, such as intra-tumoral injection of chemotherapy, are under development. Regarding the bronchoscopic treatment of peripheral lung malignancies, it follows the steps of percutaneous local therapies under CT guidance, potentially reducing the risk of pneumothorax. In addition to the ablative therapies employed in the treatment of MCAO, various other modalities, including radiofrequency ablation, bronchoscopic thermal vapor ablation, and pulsed electric field, have been investigated for their efficacy in addressing peripheral lung malignancies. However, it is important to note that most modalities are still in the developmental stage, necessitating further research to establish their efficacy and associated benefits. This review aims to provide a comprehensive overview of the current state of these bronchoscopic interventions in order to guide future advancements and optimize patient care in the field of thoracic oncology.