[Metastatic renal cell carcinoma: therapeutic concepts for non-medicinal treatment]

Area of Science:

• Oncology
• Surgical Oncology
• Medical Oncology

Context:

• Metastatic renal cell carcinoma (mRCC) presents a significant clinical challenge with a median overall survival of approximately 2 years.
• Current treatments for mRCC involve tyrosine kinase inhibitors (TKIs) and antiangiogenic agents, primarily VEGF receptor antagonists.
• The prognosis for mRCC remains poor despite advances in systemic therapies.

Purpose:

• To evaluate the role of surgical debulking (nephrectomy or metastasectomy) in conjunction with medicinal therapy for metastatic renal cell carcinoma.
• To assess the potential for curative intent through complete resection of limited metastases in mRCC patients.
• To highlight the established role of radiotherapy in managing brain metastases from renal cell carcinoma.

Summary:

• Surgical tumor debulking, including nephrectomy or metastasectomy, prior to initiating medicinal therapy may enhance clinical response in mRCC patients with good performance status.
• Complete resection of solitary or a limited number of metastases presents a potential curative option for select mRCC patients.
• Radiotherapy is the standard palliative treatment for brain metastases, aiming to alleviate symptoms and improve intracranial tumor control.

Impact:

• Integrating surgical debulking into treatment algorithms could improve survival rates and clinical outcomes for patients with metastatic renal cell carcinoma.
• Identifying patients amenable to complete metastasectomy can lead to improved long-term survival and potentially cure.
• Optimizing multimodal treatment strategies, including surgery, targeted therapy, and radiotherapy, is crucial for managing advanced renal cell carcinoma.