Treating Oligometastatic Renal Cell Carcinoma

The management of an oligometastatic recurrence represents a challenging area in the treatment of patients with renal cell carcinoma (RCC), with local options gaining broader acceptance. For patients with relatively slow growing oligometastatic disease there is an opportunity for surgical resection, explains Eric Jonasch, MD.

Newer technologies, such as focused-beam stereotactic radiosurgery, can be used in various parts of the body, especially the brain, to treat oligometastatic disease, notes Thomas E. Hutson, DO, PharmD. Theories supporting the abscopal effect have suggested that administering radiation to one area results in tumor necrosis and subsequent control of cancer elsewhere by the immune system. However, randomized trials are still needed to prove this connection, notes David F. McDermott, MD.

While local approaches are effective for some patients, they may not be appropriate in every situation. Sarcomatoid RCC tends to be more aggressive, especially when surgery is performed, and may not be optimally managed by surgical intervention. The healing factors from surgery may promote the growth of sarcomatoid lesions, notes Jonasch. Stereotactic radiosurgery is an ideal option for patients with oligometastatic brain metastases following systemic therapy, adds Jonasch.

The integration of surgical and radiation disciplines in the course of a patient’s disease is imperative if they have progression in the bone or brain, states McDermott. In this setting, tyrosine kinase inhibition is less effective. The appropriate integration of surgical approaches for metastatic disease late in the biology of an individual’s disease can have positive outcomes.