Bronchogenic carcinoma is a malignant neoplasm arising from the epithelial cells lining the bronchial airways. It is the leading cause of cancer-related mortality worldwide and the third most commonly diagnosed malignancy in Germany. Approximately 57,000 people are newly diagnosed each year in Germany, with men and women affected at nearly equal rates.
Approximately 70% of bronchogenic carcinomas are diagnosed only after progression to a locally advanced or metastatic stage (stage III–IV), as early-stage disease frequently remains asymptomatic. Structured lung-cancer screening using low-dose computed tomography (LDCT) is now recommended in the German S3 guideline for individuals at high risk, particularly heavy smokers aged 50–75 years.
Two principal histological groups are distinguished, differing substantially in tumor biology, clinical course, and therapeutic management.
Small cell lung cancer is characterized by rapid tumor growth, early metastatic dissemination, and a very strong association with heavy tobacco exposure. Although SCLC is initially highly responsive to chemotherapy and radiotherapy, recurrence is common. Prophylactic cranial irradiation or MRI-based surveillance plays an important role in the management of this subtype.
Early-stage bronchogenic carcinoma is frequently asymptomatic and may be detected incidentally on imaging. Clinical manifestations generally emerge as the primary tumor enlarges or as locoregional or metastatic spread develops.
When bronchogenic carcinoma is suspected, a stepwise diagnostic work-up is undertaken to establish the diagnosis, determine the histological subtype and molecular profile, and accurately define the disease stage.
The treatment of bronchogenic carcinoma is multimodal and is determined within a multidisciplinary tumor board. Therapeutic strategy is based on histological subtype, molecular biomarkers, disease stage, performance status, and pulmonary function.
Stereotactic body radiotherapy (SBRT/SABR – stereotactic body radiotherapy / stereotactic ablative radiotherapy) has fundamentally changed the management of bronchogenic carcinoma. With CyberKnife, very high biologically effective radiation doses can be focused on the tumor with submillimeter precision while maximizing protection of uninvolved lung parenchyma, the heart, esophagus, and spinal cord.
Treatment is generally delivered in 1–5 outpatient sessions and does not require general anesthesia. The CyberKnife system compensates for respiratory motion of the lung in real time through respiratory tracking, allowing the radiation beam to follow the tumor accurately throughout treatment—an important advantage in the stereotactic treatment of mobile pulmonary targets.
At the European Radiosurgery Center Munich, patients with bronchogenic carcinomas and pulmonary metastases have been treated for more than 20 years. Each treatment is individually planned in close coordination with the treating pulmonology, medical oncology, and thoracic surgery teams.
For tumors that move with respiration—for example lesions in the lung, liver, or upper abdomen—the CyberKnife® system uses a technology known as Synchrony.
Infrared LEDs or reflective markers are positioned on the patient's chest or abdomen. An infrared camera in the treatment room continuously records the movement of these external markers. At the same time, repeated X-ray images determine the actual position of the tumor or of implanted fiducial markers within the body. From these data, the system generates a correlation model linking external respiratory motion with internal tumor motion.
The robotic arm then adjusts the position of the linear accelerator dynamically and in real time, enabling the radiation beam to remain precisely aligned with the tumor throughout the respiratory cycle.
Non-small cell lung cancer (NSCLC) accounts for approximately 80–85% of all lung cancers and generally has a slower biological course than small cell lung cancer (SCLC). NSCLC encompasses adenocarcinoma, squamous cell carcinoma, and large-cell carcinoma. SCLC accounts for approximately 15–20% of cases, is characterized by rapid growth and early metastatic dissemination, and is very strongly associated with smoking. The two entities differ substantially in therapeutic strategy and prognosis.
In stage I disease, prognosis is favorable, with reported 5-year survival rates of approximately 60–90% following either surgical resection or stereotactic body radiotherapy in appropriately selected patients. Early diagnosis is therefore crucial. Low-dose CT screening is recommended for individuals at high risk, particularly heavy smokers aged 50–75 years.
CyberKnife® treatment may represent a curative-intent alternative to surgery, particularly when:
Current evidence demonstrates high local-control rates with SBRT in early-stage NSCLC, approaching those achieved with surgery in appropriately selected patients.
Pulmonary tumors move with respiration and, depending on their location, may undergo excursions of several centimeters. The CyberKnife® system tracks this motion in real time using external infrared markers and continuously adapts the beam direction through Synchrony Respiratory Tracking. The patient can therefore breathe normally while the radiation beam remains accurately aligned with the tumor, reducing the need for large motion-related safety margins that would otherwise increase radiation exposure to healthy lung tissue.
Radiosurgery is performed on an outpatient basis and generally does not necessitate restrictions in routine physical activity. Following treatment of pulmonary tumors, regular CT surveillance is required to assess treatment response. Transient radiographic consolidation within the irradiated region may initially occur as a manifestation of radiation pneumonitis and often regresses spontaneously. All follow-up examinations are scheduled individually in consultation with the treating physician.
It is important to us that you, your family members, and those close to you fully understand the relevant aspects of your disease and the available treatment options. Together with our medical partners, we accompany you throughout this process and ensure that you feel comprehensively cared for at the ERCM from the outset.
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