Safety and Efficacy of Bronchoscopic Pulsed Electric Field Ablation for Lung Cancer and Metastases

Local treatment options for progressive lung cancer or metastases located in the central or middle thirds of the lungs are limited, especially if progression occurs after radiation. In these patients, local thermal ablative therapies are fraught with complications. We investigated the safety and efficacy of local control in progressive lung and metastatic cancer by bronchoscopic pulsed electric field (PEF) ablation.

We performed an analysis of prospectively collected data of all the patients with lung and metastatic cancer to the lungs treated by bronchoscopic PEF ablation at our institution between October 2024 and April 2025.

Seven lesions in six consecutive patients were treated by PEF ablation using robotic bronchoscopy with three-dimensional imaging. There were three patients with NSCLC, and three with colorectal cancer, urothelial cancer, and thyroid cancer. All patients had progressed on standard oncologic therapies, and five had received radiation to the lesions. The median tumor size was 2.1 cm (range, 1.1-4 cm), and all were located in the central or middle-thirds of the lungs. At the median follow-up of 9.7 (interquartile range, 5.4-10.1) months, four (57.1%) lesions increased in size, two (28.5%) decreased, and one (14.3%) resolved. The decreased size or resolution of lesions was seen in the three patients with NSCLC. No direct complications due to PEF were encountered, but one patient required prolonged mechanical ventilation related to anesthesia.

In patients with lung cancer or lung metastases, bronchoscopic PEF ablation is safe and associated with mixed local control.