Metastatic Bone Disease in Kidney Cancer

Renal cell carcinoma (RCC) remains among the top 10 most common types of cancer in the USA with an estimated 13,920 deaths in 2022. Renal cell carcinoma represents a spectrum of tumors that are significantly different with respect to their cell type origin and type of genetic mutations. Metastatic lesions are quite common in RCC, with the lungs and bones being the most common site of metastases. One-third of patients with RCC present with metastatic disease at the time of diagnosis, and up to a third of patients develop metastasis after surgical treatment for localized disease. RCC bone metastasis is osteolytic and can therefore cause skeletal-related events and are further associated with a poor prognosis. Historically, metastatic RCC (mRCC) has had a dismal prognosis, but in the last decade, systemic treatment has evolved to include anti-angiogenic targeted treatments and immune checkpoint inhibitors. Treatment of bone metastases in mRCC is an active area of investigation with consideration for systemic, radiotherapy, and surgical approaches.