Metastatic Renal Cell Carcinoma to the Spine and the Extremities

Evaluation, Diagnosis, and Treatment

Abstract

• » 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.