Bronchoscopic treatments for early‐stage peripheral lung cancer: Are we ready for prime time?

Abstract

Lung cancer is the leading cause of cancer-related death worldwide and surgical lobectomy remains the preferred therapy for patients with early-stage NSCLC. Medical comorbidities and advanced age preclude resection in many patients and minimally invasive ablative therapies are needed for treatment. Stereotactic ablative radiation is established as an effective modality in this patient group, although may be contraindicated in some patients with prior radiation exposure, comorbidities or centrally positioned tumours. Percutaneous ablative methods are available, although are frequently associated with significant complications. Numerous endoscopic ablative techniques are under evaluation. With a more favourable safety profile and the ability to provide diagnosis and staging information potentially within a single procedure, there is a strong rationale for development of bronchoscopic ablative modalities. In the following article, the authors aim to explore the role bronchoscopic ablation may play in treatment of peripheral lung tumours, and to describe a pathway to establishing these modalities as part of routine care. The current status of several bronchoscopic ablative options is discussed in detail.

Feasibility of comprehensive genotyping specimens from radial endobronchial ultrasonography and electromagnetic navigation bronchoscopy

“…Another interesting point is the equivalent sensitivity for smaller lesions (89.4% for lesions <30 mm compared to 85.5% for lesions ≥30 mm). This is an attractive result that should reinforce the place of these mini-invasive bronchoscopic diagnostic (and potentially therapeutic [ 15 ]) procedures for lung nodules, especially after the recent positive outcomes of the lung cancer screening NELSON trial [ 16 ].…”

Bronchoscopic Thermal Vapour Ablation for Localized Cancer Lesions of the Lung: A Clinical Feasibility Treat-and-Resect Study

“…Bronchoscopic ablation is likely to be significantly safer than current percutaneous techniques, which are associated with pneumothorax rates up to 60% [4] and intercostal drain requirement in up to 38% [5], which is clearly problematic for a modality likely to be applied in multiply comorbid patients. Haemorrhage, haemoptysis, and effusion are also frequently reported complications following percutaneous tumour ablation [20]. In physiologically frail patients, bronchoscopic ablation may allow diagnosis (using rapid on-site evaluation [21]), staging [22], and treatment to be completed in a single procedure.…”

“…Numerous clinical studies are underway examining multiple novel devices for bronchoscopic tumour ablation, with a recently published review summarizing the published evidence for individual modalities [20]. Radiofrequency ablation and photodynamic therapy remain, prior to this study, the only modalities where bronchoscopic experience in ablation of peripheral tumours in clinical settings has been reported [20]. Studies examining bronchoscopically delivered microwave ablation, bronchoscopic laser interstitial thermal therapy, and cryoablation are limited to preclinical settings.…”

Thermal ablation in non-small cell lung cancer: a review of treatment modalities and the evidence for combination with immune checkpoint inhibitors

“…The mechanism by which each modality induces tumour destruction has been described extensively in the literature (6)(7)(8)(9). Ablative modalities are delivered percutaneously directly into the tumour in current clinical practice, but bronchoscopic ablative techniques are in development (10,11).…”