Summary by Dr. Riccardo Bertolo
The ideal approach to the oligometastatic patient is still debated in the field of renal cell carcinoma (RCC), even after the results of the CARMENA and SURTIME trials have been published and have impacted international guidelines.
Dr. Bertolo was asked to stimulate the discussion amongst the panellists in the multidisciplinary discussion on oligometastatic disease in kidney cancer by means of a clinical case scenario. As a result, the case of a non-symptomatic, elderly patient, with optimal performance status affected by a large locally advanced right-sided renal tumour with bulky lymph-nodal disease and two metastases (one to the right crus, one to a subcarinal node) was presented.
Several hot issues were raised and addressed: first, the optimal pre-treatment staging; second, the appropriateness of the prognostic scores used to classify the patient before indication to treatment (IMDC / MSKCC); third, the indication for biopsy before systemic treatment and what the pathologist should look for in such a biopsy with the relative implications depending on the final histology; fourth, any changes in the treatment strategy / pathway depending on the patient’s performance status and whether only sub-diaphragmatic disease localisations are found at preoperative staging (no chest metastases).