Metastatic renal cell carcinoma to the spine and the extremities evaluation, diagnosis, and treatment

Approximately 50% of patients with renal cell carcinoma (RCC) willpresent with an osseous metastasis (30% to the spine), resulting insubstantial pain, neurologic dysfunction, or pathologic fractures.» RCC metastases have traditionally been difficult to manage becauseof their large, highly destructive, hypervascular nature; they arerelatively resistant to chemotherapy and radiation therapy.» In the spine, surgery ranging from decompression with internalfixation to total en bloc spondylectomy has been described. In theextremities, excision of the lesion with reconstruction using internalfixation or an endoprosthesis often is recommended.» Given the vascular nature of the tumor, preoperative angiographyand embolization reduce intraoperative blood loss. Debate continuesregarding 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 theseagents is relatively unknown.