Endoscopic treatment for lung cancer in medically inoperable patients

Due to the increasing incidence of abnormal pulmonary lesions, there has been a growing demand for local treatment options for lung malignancies. For medically-inoperable patients with underlying comorbidities, transbronchial endoscopic treatment has a vital role. Transbronchial therapy for lung tumors has a favorable strategy as it avoids pleural punctures. Recent advancements in navigation and confirmation technologies have significantly improved the accuracy of tool placement, enabling the treatment of centrallylocated tumors, and also peripheral lung tumors, with high efficiency. Here, we present an overview of the evolution and recent advancements in transbronchial local treatments for lung malignancies, including therapy (PDT), brachytherapy, and pulsed electric field (PEF)-based therapy. We also discuss critical factors contributing to the success of the transbronchial treatment, including localization and anesthesia strategies. Additionally, in recent years, it has been reported that some ablative treatments may activate the immune system by the release of tumor-associated antigens from damaged cancer cells, resulting in additional antitumor effects. This paper discusses the evidence regarding these additive effects on ablative therapies. The field of endoscopic treatments for peripheral lung malignancy remains relatively underexplored, with limited publications available. The paper concludes by summarizing the prospects for future developments in this area.