Treatment of stage 4 lung cancer in Germany | Booking Health

Treatment of stage 4 lung cancer in Germany

The article was reviewed by an expert in the field of medicine Prof. Dr. med. Thomas Vogl
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If you need detailed information on methods and costs of treating earlier-stages lung cancer, you'll find it here.

Lung cancer is the most common group of malignant tumors in the world, which develops from cells in the lungs and bronchi. It develops 10% more often in men than in women. Today, Germany can offer new treatment methods, which allow for achieving excellent results even at stage 4 of the pathology. The patients' life quality can be improved, and their life expectancy can be increased as well.


  1. Classical treatment methods and their risks
  2. New treatment methods for stage 4 lung cancer in Germany
  3. Treatment of metastases
  4. Treatment of complications
  5. Why is it worth undergoing lung cancer treatment in Germany?
  6. How to go for treatment in German hospitals?

Classical treatment methods and their risks


In the fourth stage lung cancer, patients have lesions of both lungs, the tumor spreads to the pleura and metastasizes to other parts of the body. Patients often suffer from a life-threatening complication – the accumulation of fluid in the membranes covering the heart and lungs (malignant pericardial, or pleural effusion). 

Standard treatment usually involves chemotherapy, radiation therapy, and major surgery to remove (resect) the tumor. However, their use is associated with certain risks. These are as follows:

  • Anticancer drugs are highly toxic and affect not only cancer cells, but also healthy ones.
  • Standard equipment for radiation therapy involves total body irradiation, which can cause unpleasant side effects in patients.
  • Classic surgery requires a thoracotomy and a long postoperative recovery. In addition, there is a high risk of bleeding during such interventions.
  • It is almost impossible to remove all tumor tissues during operations, and therefore there is a high risk of repeated development of the process (recurrence).
  • All of them affect the life expectancy of patients and are very expensive.

Germany has developed and introduced into practice improved technologies for chemotherapy, radiation therapy, and lung cancer surgery. They are more effective than classical methods and demonstrate excellent survival rates.

New treatment methods for stage 4 lung cancer in Germany


New treatments for lung cancer stage 4 are aimed at increasing life expectancy, improving its quality, preventing, and eliminating complications. To achieve success in therapy, German oncologists use such methods as embolization, innovative drugs for pharmacotherapy, surgical interventions, and others.

Embolization of metastases in Germany


Embolization of tumor vessels is a minimally invasive surgical method, which consists in blocking blood flow in the vessels supplying the malignant tumor. The doctors most often close the lumens of the bronchial arteries. It occurs due to the introduction of emboli – chemicals based on polyvinyl alcohol, hydrophilic microspheres, and others. If the artery is dilated, micro coils are used.

Embolization results in tumor size reduction, bleeding control, and normalization of the patient's condition. In addition, embolization can be performed to create favorable conditions for further drug therapy. The procedure is effective in more than 90% of cases and has the following advantages:

  • Minimal invasiveness – chest incisions are not required since the doctor reaches the arteries by inserting a catheter through an incision in the groin.
  • No need for general anesthesia – it is enough to use local anesthesia in the catheterization area.
  • The procedure can be performed even in emergency cases to stop massive pulmonary hemorrhage.

In most cases, embolization is used as a maintenance treatment option in case of hemorrhage and hemoptysis with the excretion of more than 200 ml of blood.


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Embolization is often combined with localized chemotherapy. This procedure is called transarterial chemoembolization. It uses microspheres saturated with chemotherapy drugs. The last ones clog the vessels, that way stopping hemorrhage and reducing the blood supply to the neoplasm. An additional effect is achieved due to the release of anticancer drugs for several weeks after the procedure. They enter the tumor in high concentrations, and therefore they have a more pronounced effect on it as compared to systemic chemotherapy.

For selective chemoembolization in lung cancer treatment, German oncologists use a contrast agent to assess the blood supply to the tumor and inject emboli into small-caliber vessels, which are located as close to the pathological foci as possible. It allows the doctors to improve the procedure outcomes and increase its safety since less healthy lung tissue suffers from ischemia (lack of oxygen).

Embolization can sometimes be combined with procedures and surgery to restore the patency of the bronchi. The preliminary closure of the vascular lumen reduces the blood supply to the tumor and therefore increases radiofrequency or laser ablation efficiency.


Treatment of stage 4 lung cancer in Germany


Immunotherapy for the treatment of lung cancer stage 4 in Germany


Most cancer cells have checkpoints on their surface. These are signaling molecules that help cancer cells avoid the body's immune response. Immunotherapy is a drug treatment based on the usage of checkpoint inhibitors (blockers). The drugs completely suppress the activity of tumor-masking molecules, which allows the immune system to attack the tumor.

Immunotherapy has the following benefits:

  • This type of therapy reduces the size of the tumor, stops the division of cancer cells, and significantly slows down the growth of the neoplasm.
  • The drugs are selected individually after an accurate study of the tumor cell type.
  • Checkpoint inhibitors do not affect healthy tissues and organs, and therefore they almost do not have any side effects.
  • Immunotherapy does not cause severe complications.

For immunotherapy of metastatic lung cancer, drugs targeting PD-L1, PD-1, and CTLA-4 proteins are prescribed. These drugs are so effective that they have recently been used as the main treatment.

Targeted therapy for the treatment of lung cancer stage 4 in Germany


Targeted therapy is the treatment with medications that block the growth and spread of a tumor by affecting the cellular mechanisms involved in this process. This technique can be used for the following purposes:

  • Cancer stabilization and its transfer from the stage of active growth to the stage of remission.
  • Preparations for other treatment methods to reduce the dose of chemotherapy or irradiation.
  • Prevention of recurrence and control of metastasis growth.
  • Due to their low toxicity, targeted therapy drugs can be prescribed in cases when chemotherapy is contraindicated for IV stage lung cancer because of the patient's severe condition.

The treatment is selected individually according to genetic tests. Mutations in ALK, EGFR, ROS1, BRAF, RET, MET, and NTRK genes can be detected in tumor cells. Different drugs are used for patients with different mutations.

Treatment of metastases


Lung cancer often spreads metastases to the brain. If the tumor and its metastases are well controlled, doctors in Germany appoint neurosurgical interventions to remove neoplasms in the central nervous system. They are often performed using robot-assisted equipment. It means that the intervention is performed by a robot, while the doctor only controls this process.

Another treatment option is radiation therapy. Small tumors can be irradiated with high radiation doses within a single radiosurgery session. In this case, the radiation source is directed only at the tumor, without affecting healthy tissues.

Large metastatic tumors or those located close to vital brain areas are destroyed with stereotactic radiation therapy. The latest techniques allow the doctors to avoid fixing the rigid frame with screws to the patient's skull during the operation, which reduces the injury rate of the procedure. Whenever possible, irradiation is carried out within 2-7 sessions. It is often supplemented with prophylactic cranial irradiation to avoid new metastases.

Treatment of complications


The main problems that can occur in stage 4 lung cancer include respiratory failure due to airway obstruction, fluid accumulation in the pleural or pericardial cavities, pulmonary hemorrhage, and hemoptysis.

Bronchial artery embolization is used to eliminate pulmonary hemorrhage. After this procedure, the hemorrhage stops forever in most patients. In those rare cases when they do recur, doctors perform repeated embolization without any health risks.

Restoring breathing sometimes requires the destruction of the tumor areas that are blocking the large bronchi. The specialists in Germany use minimally traumatic procedures to restore their patency. The following procedures can be used to destroy tumor tissue:

  • Photodynamic therapy is a treatment method using light-sensitive substances (photosensitizers) and light radiation that activates them. The activation of tumor-absorbed photosensitizers has a destructive effect on cancer cells.
  • Laser or radiofrequency ablation is the destruction of tumor foci with radiofrequency or laser energy without surgery.
  • Brachytherapy involves positioning a radiation source close to a tumor to emit higher doses of radiation locally without affecting healthy tissue.

After bronchial patency restoration, it is necessary to prevent the recurrent development of obstruction. To achieve this, stents are implanted into the bronchial lumen. These may be metal or silicone tubes, which help the patient breath.

The problem of fluid accumulation in the pleural cavity can also be successfully solved. To treat pleurisy, pleurodesis is used. The doctors insert a thin tube into the pleural cavity, through which they pump out fluid and inject chemicals that cause the pleura to stick together. As a result, the cavity, where liquid may accumulate, disappears. If this procedure is ineffective, a catheter can be inserted into the pleural cavity. It drains fluid into the abdominal cavity or the external environment. Another option is minimally invasive surgery to remove the pleura.

The fluid can sometimes accumulate inside the pericardium. It results in heart compression, which interferes with its normal functioning. A pericardial window is created to eliminate this pathological condition. The doctor performs minor surgery to ensure a constant outflow of fluid from the pericardium into the thorax or abdominal cavity.


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Why is it worth undergoing lung cancer treatment in Germany?


Oncology hospitals in Germany are constantly improving, which leads to a huge flow of foreign patients from all over the world. It is possible due to the following advantages:

  • State-of-the-art equipment at the hospitals – each medical facility has the best equipment. It provides accurate diagnostics and successful performance of any intervention.
  • Innovative technologies – many conditions that until recently were considered lethal in stage 4 lung cancer can be successfully eliminated nowadays. The reason is the development and implementation of new treatment protocols in Germany.
  • The best specialists – each oncologist undergoes long training at prestigious universities and constantly undergoes specialized training courses.

More than 50 specialized German hospitals provide treatment for stage four lung cancer.  Among them, the leading and the most successful ones are:

  1. St. Vincentius Hospital Karlsruhe – Academic Hospital of the University of Freiburg, Department of Pulmonology
  2. University Hospital RWTH Aachen, Department of Cardiology, Pulmonology and Angiology
  3. University Hospital Frankfurt-am-Main, Department of Gastroenterology, Hepatology, Pulmonology, Allergology, Endocrinology and Diabetology
  4. University Hospital Jena, Department of Cardiology, Angiology, Pulmonology and Intensive Care
  5. University Hospital Duesseldorf, Department of Cardiology, Pulmonology and Angiology

How to go for treatment in German hospitals?


To undergo stage 4 cancer treatment in the best European hospitals, you can use the services of Booking Health – an international medical tourism agent. 

The employees of Booking Health provide the following services:

  • Personalized selection of a diagnostic and treatment program in Germany, taking into account previously performed procedures.
  • Provision of a minimum cost of treatment – prices will be reduced due to the lack of additional fees for foreign patients.
  • Preliminary consultation with an experienced doctor.
  • Booking the desired dates for visiting the hospital.
  • Preparation of a medical program.
  • Preparation of documents and insurance against complications.
  • Treatment monitoring at all stages.
  • Monitoring of invoices and return of unspent funds.
  • Assistance in buying and forwarding medicines.
  • Organization of additional procedures.
  • Buying airline tickets, booking a hotel or an apartment, meeting upon arrival in Germany, and transfer.
  • Communication with the attending physician after returning home.

You can find out more detailed information about treatment in Europe and the average cost of treatment by sending your request on the official website.


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The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Alexandra Solovey. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Our editorial policy, which details our commitment to accuracy and transparency, is available here. Click this link to review our policies.



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