Initial complete local therapy without systemic therapy versus systemic-therapy-based management in selected patients with oligometastatic renal cell carcinoma: a matched comparative study
In brief
Local therapy alone linked to 73% five-year survival in selected kidney cancer patients
In a matched study of 72 pairs with oligometastatic kidney cancer after nephrectomy, 73% treated initially with local therapy alone were alive at five years, compared with 59% receiving systemic-therapy-based care. Cancer-specific survival was also higher, but progression-free survival was similar, and about half later started systemic therapy. Because treatment was not randomized, the findings do not establish superiority over current immunotherapy-based care.
- Journal
- Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology (Q1)
- Published
- 13 October 2026
- Study design
- Non-randomized / quasi-experimental trial
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Ha Un Kim, Hye In Lee, Inkeun Park, Jung Kwon Kim, Yeon Joo Kim
- PMID
- 42869248
- DOI
- 10.1016/j.radonc.2026.111827
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 14 October 2026): Initial complete local therapy vs systemic therapy in oligometastatic RCC
Abstract
OBJECTIVES: To compare survival outcomes of initial complete metastasis-directed therapy (MDT) without systemic therapy (ST) and ST-based management in patients with oligometastatic renal cell carcinoma (RCC). MATERIALS AND METHODS: We retrospectively reviewed patients with oligometastatic RCC (≤5 lesions) treated between 2015 and 2023. Patients were categorized as MDT alone (surgery, radiotherapy, or both, without ST) or ST ± local treatment. One-to-one exact matching between the initial MDT-alone and ST-based groups was performed using six covariates (lesion count, timing of presentation, IMDC risk, Charlson comorbidity index, number of involved organs, and performance status). RESULTS: Among 276 patients (MDT, n = 173; ST, n = 103), 72 pairs were generated after exact matching. Median follow-up was 86.2 months for the MDT and 71.6 months for the ST group in the matched cohort. MDT alone was associated with higher 5-year overall survival (OS) (73.0 % vs. 58.6 %; hazard ratio [HR] 0.45, 95 % confidence interval [CI] 0.26-0.77, p = 0.004) and cancer-specific survival (CSS) (83.7 % vs. 69.8 %; HR 0.35, 95 % CI 0.18-0.67; p = 0.001) in the matched cohort. Progression-free survival (PFS) and distant metastasis-free survival (DMFS) did not differ between groups. In the MDT alone group, the 5-year cumulative incidence of subsequent ST initiation was 48.6 %. In the whole cohort, the association was consistent across IMDC risk groups (p-interaction = 0.898). CONCLUSIONS: In this selected post-nephrectomy cohort, an initial complete-local-therapy strategy without ST was associated with higher OS and CSS than heterogeneous, predominantly TKI-based ST management, although PFS and DMFS were similar. Given the nonrandomized treatment allocation and residual biological selection, these findings are hypothesis-generating and should not be interpreted as evidence of superiority over contemporary ICI-based therapy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.