Surgery is the primary treatment of skeletal metastases from renal cell carcinoma, because radiation and chemotherapy frequently are not effecting the survival. We therefore explored factors potentially affecting the survival of patients after surgical treatment.

Bone is a major site of haematogenous tumour cell spread in renal cell carcinoma (RCC), and most patients with RCC will develop painful and functionally disabling bone metastases at advanced disease stages. The prognosis of these patients is generally poor and the treatment is, therefore, aimed at palliation. However, RCC-associated bone metastases can be curable in select patients. Current data support a multimodal management strategy that includes wide resection of lesions, radiotherapy, systemic therapy, and other local treatment options, which can improve quality of life and survival. Nevertheless, the optimal approach for metastatic bone disease in RCC has not yet been defined and practical recommendations are rare. To improve the management and outcomes of patients with RCC and bone metastases, the International Kidney Cancer Coalition and the interdisciplinary working group on renal tumours of the German Cancer Society convened a meeting of experts with a global perspective to perform an unstructured review and elaborate on current treatment strategies on the basis of published data and expertise. The panel formulated recommendations for the diagnosis and treatment of patients with RCC and metastasis to the bone. Furthermore, the experts summarized current challenges and unmet patient needs that should be addressed in the future.

High dose local stereotactic radiosurgery was performed in select patients to improve local tumor control and overall survival. We report on patients with renal tumors treated with single fraction robotic stereotactic radiosurgery. A total of 40 patients with a median age of 64 years who had an indication for nephrectomy and subsequent hemodialysis were entered in a prospective case-control study of single fraction stereotactic radiosurgery. Of the patients 11 had transitional cell cancer and 29 had renal cell cancer. Tumor response, renal function, survival and adverse events were estimated every 3 months. Followup was at least 6 months. A total of 45 renal tumors were treated. Median followup was 28.1 months (range 6.0 to 78.3). The local tumor control rate 9 months after stereotactic radiosurgery was 98% (95% CI 89-99). There was a measurable size reduction in 38 lesions, including complete remission in 19. Renal function remained stable. Using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation median creatinine clearance was 76.8 (range 25.3 to 126.3) and 70.3 ml/minute/1.73 m(2) (range 18.6 to 127.3) at baseline and followup, respectively (p = 0.89). Grade I erythrodermia developed in 1 patient, 3 reported grade I fatigue and 2 reported grade I nausea. Nephrectomy was avoided in all cases. Single fraction stereotactic radiosurgery as an outpatient procedure is a treatment modality with short-term safety and efficacy. It avoids treatment related loss of renal function and hemodialysis in select patients with transitional or renal cell cancer. At short followup oncologic results were similar to those of other ablative techniques for renal tumors. To date functional results have been excellent. Further studies are needed to determine the long-term results and limits of stereotactic radiosurgery in this setting.