Metastasectomy in renal cell carcinoma patients when and how?

Metastatic renal cell carcinoma has a variable natural history. Therefore treatment choice depends on disease and patient factors, but most importantly disease burden and site of metastasis. renal cell carcinoma

A new study published in Current Opinion in Urology Journal suggests that, a metastasectomy should only be performed in patients with renal cell carcinoma when a full resection is possible, unless the aim of the treatment is to relieve symptoms.

At the time of diagnosis, over 30% of patients with renal cell carcinoma (RCC) had metastatic illness. About 25% of men who get treatment for localized RCC go on to develop metastatic illness. Metastases are frequently seen in the liver (19%–40%), bone (39%–40%), lymph nodes (60%–65%), lung (60%–75%), and brain (5%–7%). The current range of therapeutic options for metastatic RCC (mRCC) includes metastasectomy, systemic therapy, clinical trial enrollment, and observation. There are no suggestions as to which of these modalities should be used more frequently.

The natural history of metastatic renal cell carcinoma varies. The illness, the patient, and most crucially the place of the metastasis all influence the choice of treatment. The authors of this paper, Alexander Lloyd and colleagues, underline important factors to take into account when patients with renal cell carcinoma are considering metastasectomy and offer a narrative assessment of the supporting data.

This study highlights the following:

1. Different recurrence patterns are related to different tumor subtypes.

2. More time has passed since the original nephrectomy and improved results are seen in patients with a single or small number of metastatic locations.

3. In particular, local recurrence is oncologically sound and amenable to minimally invasive surgical resection.

4. Although lung and endocrine metastases have better results, very carefully chosen cases of liver or brain metastases may benefit from metastasectomy.

5. Although the location and severity of the illness are significant, the ability to obtain a full resection is the main factor determining the success of a metastasectomy.

6. Currently, adjuvant therapy is not recommended.

In conclusion, research in this area is necessary, especially as systemic treatment and minimally invasive surgical methods advance. Future study will be crucial in elucidating tumor biology to guide patient selection.

Reference:

Lloyd, A., Reeves, F., Abu-Ghanem, Y., & Challacombe, B. (2022). Metastasectomy in renal cell carcinoma: where are we now? In Current Opinion in Urology (Vol. 32, Issue 6, pp. 627–633). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/mou.0000000000001042