New diagnostic and nonsurgical local treatment modalities for early stage lung cancer

Highlights•This paper provides an overview about the rapid developments in the field of new diagnostic and nonsurgical local treatment modalities for early stage lung cancer. We will highlight developments in diagnostic and nonsurgical local treatment modalities that have changed the management of early-stage lung cancer. These innovations aim to enhance diagnostic accuracy, minimize invasiveness, and improve patient outcomes.•Liquid biopsies are emerging as promising tools for non-invasive diagnosis and monitoring, enabling earlier intervention without being standardized yet as well as not yet anchored in the guidelines. Advanced navigational techniques used in the diagnosis of lung cancer are evolving rapidly enabling accurate biopsy of small, peripheral lesions that were once challenging to sample, with a very low pneumothorax rate.•Regarding nonsurgical treatments, stereotactic body radiotherapy (SBRT) with photons continues to shine as a non-invasive local treatment modality for early-stage lung cancer and is the guideline-recommended standard-of-care for inoperable patients and patients refusing the risk of surgical resection. The low toxicity and excellent local control has made it an attractive alternative to surgery even in fitter patients. We also discuss the role of proton instead of photon radiation in this patient group. Finally, we give an overview of endobronchial or percutaneous ablative techniques utilising energies such as microwave or pulse-field electroporation as options for patients who are not candidates for surgery or SBRT.AbstractThis paper highlights developments in diagnostic and nonsurgical local treatment modalities that have changed the management of early-stage lung cancer. These innovations aim to enhance diagnostic accuracy, minimize invasiveness and improve patient outcomes.Liquid biopsies are emerging as promising tools for non-invasive diagnosis and monitoring, enabling earlier intervention without being standardized yet as well as not yet anchored in the guidelines. Endobronchial navigation has emerged as an innovative tool. By combining electromagnetic or GPS-like technology with 3D imaging and a steerable catheter, it enables accurate biopsy of small, peripheral lesions that were once challenging to sample, with a very low pneumothorax rate.Regarding nonsurgical treatments, stereotactic body radiotherapy (SBRT) continues to shine as a non-invasive local treatment modality for early-stage lung cancer and is the guideline-recommended standard-of-care for inoperable patients and patients refusing the risk of surgical resection. The low toxicity and excellent local control has made it an attractive alternative to surgery even in fitter patients. Percutaneous ablative techniques utilising energies such as microwave or pulse-field electroporation are options for patients who are not candidates for surgery or SBRT. Bronchoscopic ablation delivers the same energies but with a very lower pneumothorax rate and it is therefore also open to patients with multiple and bilateral lesions.