Advances in Percutaneous and Endovascular Locoregional Therapies for Primary and Metastatic Lung Cancer

Many patients with primary or metastatic lung cancer are not candidates for surgery, additional radiation, or further systemic therapy due to advanced age or comorbidities; this creates a need for minimally invasive locoregional options. Image-guided thermal ablation (IGTA) is being applied across a broader spectrum of lesions, while bronchial artery chemoembolization (BACE) is emerging as a therapy option for treatment-refractory advanced disease. Recent studies in thermal ablation have focused on optimizing energy delivery and protocols, as well as improving ablation zone predictability and analysis. Advances in lesion targeting, including cone beam CT fusion, electromagnetic guidance, and robotic-assisted ablation, allow for treatment of subcentimeter and ground-glass lesions in anatomically challenging locations. Growing clinical experience supports IGTA for intrathoracic oligoprogression and as salvage therapy after recurrence. In the endovascular space, improved imaging, microcatheters, and drug-eluting microspheres have expanded the use of BACE for disease and symptom control in advanced lung cancer. Multimodal strategies combining minimally invasive locoregional treatments with systemic therapies and radiation are being explored, with early data showing improvements in survival without increased toxicity. This narrative review synthesizes emerging techniques, clinical data, and indications for percutaneous and endovascular lung cancer treatments and underscores the need for prospective and randomized trials to refine patient selection, treatment sequencing, and long-term outcomes.