Role of metastasis‐directed treatment in kidney cancer

• Published in: Cancer Vol. 124; no. 18; pp. 3641 - 3655
• Main Authors: Psutka, Sarah P., Master, Viraj A.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15.09.2018
• Subjects: Ablation; Clinical decision making; Decision making; embolization; Kidney cancer; Kidneys; metastasectomy; Metastases; Metastasis; metastatic renal cell carcinoma; Oncology; Palliation; prognostication; radiation; Radiation therapy; Renal cell carcinoma; shared decision making; Surgery; Surgical instruments; systemic therapy; thermal ablation; kidney cancer; shared decision making; embolization; thermal ablation; metastasectomy; radiation; prognostication; metastatic renal cell carcinoma; systemic therapy
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.31341

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. Despite the abundance of novel systemic treatments now approved for the treatment of metastatic renal cell carcinoma, a complete response is rarely obtained. Locally directed therapy, including surgical metastasectomy or other ablative techniques resulting in the absence of identifiable disease, does result in a durable response. Herein, the data supporting surgical and nonsurgical management of metastatic renal cell carcinoma for both local tumor control and symptom palliation are reviewed.