Role of metastasis‐directed treatment in kidney cancer

Abstract

Despite the rapid elaboration of multiple, novel systemic agents introduced for metastatic renal cell carcinoma (mRCC) in recent years, a durable complete response remains elusive with systemic therapy alone. Definitive treatment of the metastatic deposit remains the sole potentially curative option and is a cornerstone of mRCC therapy, offering potential for both local control and palliation of tumor-related symptoms. In this review, the evidence supporting the definitive treatment of mRCC is examined and summarized, including the use of surgical metastasectomy, thermal ablation, radiotherapy, and other minimally invasive options. Multimodal approaches, including the combination of metastasectomy with novel systemic agents, are discussed. Finally, the authors review considerations for patient selection for this type of therapy and summarize available risk-stratification tools that may help guide shared decision making.

Sec23a mediates miR-200c augmented oligometastatic to polymetastatic progression

“…Curative intent is only applied to early-stage localized tumors. Recent studies show that in contrast to widespread polymetastases, oligometastatic patients who have limited number or spread of metastases may benefit from metastasis-directed local treatments [ [1] , [2] , [3] , [4] ]. Surgical resection has been proven to have curative effects on limited metastases in lung [ 5 , 6 ], liver [ 7 , 8 ] and breast [ 9 , 10 ].…”

Twenty-year survival after iterative surgery for metastatic renal cell carcinoma: A case report and review of literature

“…Renal cell carcinoma (RCC) accounts for 3% to 5% of all adult malignancies[ 1 ], with an increasing incidence in the last decades, but with a concomitant progressive improvement of survival rates[ 2 - 4 ]. Metastatic RCC (mRCC) has been for long characterized by a dismal prognosis, which has however dramatically improved in the last decades because of the recent development of multiple novel therapeutic agents[ 5 , 6 ]. Approximately 20%-40% of patients have synchronous metastases at the time of diagnosis, while 20%-40% develop recurrent disease after potentially curative resection of localized RCC[ 4 , 6 , 7 ].…”

Long-term Outcome After Resection of Isolated Thoracic Lymph Node Metastases of Renal Cell Cancer

“…The belief is that the metastasectomy may permit a delay in the initiation of systemic therapy or the systemic therapy may be withdrawn for a time. 30 These requests might result from the limited outcomes and poor complete response rates with systemic therapies. 3,5,6 As a whole, it is important to evaluate the right time point when systemic or local therapy might help the patient.…”

“…However, although for other localizations radiation therapy data for renal cancer metastases, especially for stereotactic radiosurgery, may improve, a complete resection is still favored. 30 For this reason, even if there is no literature about how often these severe complications occur, in our opinion it is important to consider a metastasectomy in cases of hilar and mediastinal lymph node metastases, not only for the curative aspects but also for the palliative aspects, preferably before infiltration of the surrounding structures. In this way, patients can also avoid palliative therapies such as tracheal or esophageal stent implantations and their side effects.…”