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Metastatic Renal Cell Carcinoma to the Spine and the Extremities

Evaluation, Diagnosis, and Treatment

Louie, Philip K. MD1; Sayari, Arash J. MD1; Frank, Rachel M. MD2; An, Howard S. MD1; Colman, Matthew W. MD1

doi: 10.2106/JBJS.RVW.19.00002
Review Articles

  • » Approximately 50% of patients with renal cell carcinoma (RCC) will present with an osseous metastasis (30% to the spine), resulting in substantial pain, neurologic dysfunction, or pathologic fractures.
  • » RCC metastases have traditionally been difficult to manage because of their large, highly destructive, hypervascular nature; they are relatively resistant to chemotherapy and radiation therapy.
  • » In the spine, surgery ranging from decompression with internal fixation to total en bloc spondylectomy has been described. In the extremities, excision of the lesion with reconstruction using internal fixation or an endoprosthesis often is recommended.
  • » Given the vascular nature of the tumor, preoperative angiography and embolization reduce intraoperative blood loss. Debate continues regarding the proper comprehensive treatment for these patients.
  • » With the development of targeted therapies for metastatic RCC, improved survival has been shown, but the long-term effect of these agents is relatively unknown.

1Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois

2Department of Orthopaedic Surgery, University of Colorado School of Medicine, Boulder, Colorado

E-mail address for P.K. Louie:

Investigation performed at Rush University Medical Center, Chicago, Illinois

Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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