Advances in percutaneous lung ablation: techniques, outcomes, and future directions—a literature review

BACKGROUND AND OBJECTIVE: Percutaneous thermal ablation has become an important local treatment option for patients with primary or metastatic lung tumors who are not optimal surgical candidates. Radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) are increasingly used in selected patients, with expanding evidence supporting their safety and effectiveness. This review summarizes current techniques, patient selection considerations, clinical outcomes, and future directions in percutaneous lung tumor ablation. METHODS: A narrative review of the literature was performed using PubMed, MEDLINE, major radiology and oncology journals, and reference lists from key manuscripts. Searches focused on percutaneous thermal ablation modalities, outcomes, complications, and emerging technologies in lung tumor management. Representative studies were selected to illustrate current evidence and practice patterns. KEY CONTENT AND FINDINGS: Patient selection for lung ablation depends on tumor size, number, location, and pulmonary reserve. MWA provides more predictable heating zones and is less affected by heat-sink effects, while RFA is more limited in this setting. CA allows controlled ablation margins and preservation of adjacent lung parenchyma, with favorable tolerance near critical structures. Across modalities, percutaneous ablation achieves meaningful local control and survival in early-stage non-small cell lung cancer (NSCLC) and oligometastatic disease. Long-term survival after MWA for stage IA NSCLC can approach surgical outcomes in well-selected patients, though disease-free survival remains higher with resection. Compared with stereotactic body radiotherapy (SBRT), ablation generally yields lower local control but similar overall survival (OS) in some cohorts. Complications such as pneumothorax, pleural effusion, and hemorrhage are usually manageable, with CA often associated with fewer major adverse events. Emerging innovations, including bronchoscopic ablation systems, non-thermal energy platforms, and artificial intelligence (AI)-assisted planning, may enhance precision and broaden indications. CONCLUSIONS: Percutaneous lung ablation is a safe and effective local therapy for selected patients with primary or metastatic lung tumors, particularly those with limited pulmonary reserve or requiring repeat local treatment. Ongoing advances in technology and patient selection strategies are likely to strengthen its role within multidisciplinary lung cancer management.