RCC With Solitary Rib Met

Bradley G. Somer MD

Dec 02, 2016

This is a solitary metastatic recurrence. There is data supporting consideration of a potentially curative metastasectomy. I would feel stronger about this recommendation if the relapse was many years following the nephrectomy or if it was a lung based lesion (better prognostically then bone). The short duration from nephrectomy and the bone based nature implies a more concerning prognosis. Giving the benefit of the doubt that it is arising from the pleura and that it did not relapse over the 6 months, but there may not have been adequate chest imaging on initial diagnosis and it was present before, if the surgery is not overly extensive and in a young man like this, I agree with referral to  thoracic surgery for evaluation of removal of the metastases. It is unclear yet as to the total yield of molecular profiling of the tissue, but in our institution, because of access to trials, we would send off for testing. Following surgery, we would consider a trial if available. We are about to open an adjuvant PD1 inhibitor trial that includes stage 2-4 on clinical trial respected stage 4 patients. There is debate in this clinical scenario as to whether in the absence of a clinical trial to start a first line VEGF inhibitor agent such as Sunitinib or Pazopanib, and I would be inclined to do it after recovery from surgery if it is bone disease and in consideration for it being a seemingly short duration of relapse from nephrectomy.