Worldwide, approximately half of the patients diagnosed with lung cancer (LC) will develop, simultaneously or asynchronously, brain metastases (BMs). The existence of BMs negatively affects the quality of life and constitutes a poor prognostic factor, linked with high mortality. Locoregional therapy with surgery or radiation is, until now, the treatment of choice, especially for symptomatic patients; however, both options are linked to a high complication rate. The question arising here is whether, in asymptomatic patients, the benefit outweighs the risk and whether an alternative method can be used to treat this special category of patients. Over the last decade, immune checkpoint inhibitors (ICIs) have represented a major breakthrough in the field of oncology, and several molecules have been approved as a treatment option for LC. This review tried to analyze the tumor microenvironment of both the primary lung tumor and the BMs in order to evaluate the intracranial activity of ICIs, outline the main challenges of including these agents in the treatment of LC with BMs, highlight the available information from the main clinical trials, and mark the potential positive effect of choosing a combination therapy. In conclusion, it appears that immunotherapy has a positive effect, inhibiting the progression of BMs, but more data should be published specifically for this category of patients.

Echinococcosis presents diverse clinical manifestations, including pulmonary hydatidosis, often asymptomatic but complicated by rare yet dramatic occurrences like hydatoptysis. Here, we report a unique case of recurrent pulmonary and abdominal hydatidosis in a 59-year-old female with bronchial fistulization and hydatoptysis, despite previous surgical interventions. Imaging revealed characteristic features aiding in diagnosis and management decisions. The challenges in managing recurrent echinococcosis underscore the importance of comprehensive follow-up and multidisciplinary care. Surgical intervention remains pivotal, supplemented by medical therapy with careful consideration of risks and benefits. This case also presents rare images, absent in much of the literature, which provide valuable insights into the disease’s presentation and progression.

In recent years, significant efforts have been made worldwide to implement lung cancer screening programs. As a result, an increasing number of patients are being diagnosed with early-stage lung cancer, where treatment options offer higher survival rates. However, approximately 25% of these patients cannot undergo surgery due to poor respiratory function because of their primary lung disease. Image-Guided thermal ablation (IGTA) techniques are recommended by the international guidelines as an option for the medically inoperable stage IA. However, due to the need for specialized centers for their application, this technique has not yet been widely adopted. The aim of this presentation is to highlight the promising results of cryoablation as a thermal ablation technique for patients with stage IA lung cancer and severely compromised lung function. This will be illustrated by 2 cases of medically inoperable early-stage non-small cell lung cancer (NSCLC) where this treatment option was successfully employed. The procedure was well tolerated and both patients were discharged from the hospital 2 days after the procedure. The follow-up included a computed tomography (CT) scan in 1, 3, 6, and 12 months and a positron emission tomography (PET) scan in 6 and 12 months. Both patients had no local recurrence of the disease for at least 1 year afterwards. These cases highlight that cryoablation, a widely approved and guideline-endorsed technique, can be safely and effectively applied in patients with significantly impaired lung function or multiple comorbidities, offering a valuable alternative when surgery is not feasible.

Background/Objectives: Lung cancer (LC) remains the leading cause of cancer-related death worldwide, despite advances in systemic and targeted therapies. A mechanism of survival of tumor cells is metabolic reprogramming, characterized by increased glucose uptake, aerobic glycolysis, and alterations in mitochondrial function. These adaptations seem to support tumor growth, immune evasion, and therapeutic resistance. In parallel, supportive care and specifically nutritional interventions have become essential components of modern oncology. The interplay between metabolic reprogramming and targeted nutritional strategies represents a promising area of investigation that bridges tumor biology with supportive care, aiming to enhance both therapeutic efficacy and patient quality of life. Methods: This narrative review explores the biological and pathophysiological rationale for the ketogenic diet (KD) as a possible complementary intervention in LC management and summarizes the published preclinical and clinical data supporting this rationale. Results: We discuss key aspects of tumor metabolism, including the Warburg effect, glucose dependency, oxidative stress regulation, fatty acid metabolism, lactate cycling and tumor microenvironment interactions, with particular emphasis on how carbohydrate restriction and ketosis may exacerbate mitochondrial dysfunction in cancer cells and modulate inflammatory pathways. Furthermore, we summarize available preclinical and clinical evidence evaluating the KD in oncology and, more specifically, in LC, focusing on feasibility, safety, metabolic effects, and potential synergy with chemotherapy, radiotherapy, and immunotherapy. Conclusions: While preclinical models suggest enhanced treatment efficacy, clinical data remain limited and heterogeneous, with patient adherence representing a major challenge. Further well-designed longitudinal studies are required to clarify the therapeutic role of the ketogenic diet in lung cancer.