Interventional Radiology and Thoracic Oncology: 20 Years of Innovation

Since the launch of the Journal of Thoracic Oncology in 2006, interventional radiology has evolved from a predominantly palliative adjunct into a core component of multidisciplinary thoracic oncology. Advances in imaging, device engineering, and procedural techniques have expanded its role across diagnosis, treatment, and symptom control in lung cancer, pleural mesothelioma, and other intrathoracic malignancies. This review summarizes two decades of progress and clinical practice in interventional thoracic oncology.

A narrative review of the published literature from 2006 to 2026 was performed, focusing on image-guided diagnostic techniques, percutaneous and endovascular therapies, pleural interventions, and emerging technologies relevant to thoracic malignancies. Emphasis was placed on clinical outcomes, safety, patient-centered considerations, and integration within multidisciplinary care pathways.

Image-guided biopsy techniques have progressed from fluoroscopic guidance to computed tomography based, navigational, and robotic approaches, achieving high diagnostic accuracy with progressively lower complication rates. Percutaneous thermal ablation techniques, including radiofrequency, microwave, and cryoablation, provide effective local tumor control for selected patients with early stage or oligometastatic lung cancer who are not surgical candidates, with favorable survival and morbidity profiles. Endovascular interventions, such as bronchial artery embolization and chemoembolization, offer important therapeutic options for hemoptysis and advanced disease. In pleural mesothelioma, interventional radiology underpins diagnosis, effusion management, and emerging locoregional therapies. Improvements in safety, outpatient feasibility, and patient experience have been substantial.

Interventional radiology has become indispensable in thoracic oncology, spanning diagnosis, definitive and palliative treatments, and supportive care. Ongoing advances in artificial intelligence, robotics, and precision oncology are likely to further expand its clinical impact.