The widespread implementation of lung cancer screening has led to a marked increase in the detection of early-stage disease, underscoring the clinical need for less invasive treatment strategies. Interventional pulmonology has gained increasing prominence as an alternative for patients who are unsuitable candidates for surgery, leveraging real-time imaging guidance for accurate lesion localization and offering a spectrum of local ablative modalities. In this review, we outline the current evidence regarding thermal and non-thermal ablation, photodynamic therapy, and radioactive seed implantation in the management of early-stage lung cancer. Furthermore, we examine the emerging role of advanced navigation technologies and robotic bronchoscopy platforms in interventional pulmonology. Despite encouraging outcomes, several challenges remain, including heterogeneous treatment selection criteria, the lack of standardized protocols, and limited long-term survival data. Continued technological innovation and high-quality clinical studies are essential to optimize therapeutic efficacy and expand clinical indications. Interventional pulmonology is poised to contribute substantially to personalized and minimally invasive management of early-stage lung cancer, and its integration into multidisciplinary care pathways is likely to become increasingly important in the future.