Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
October 13, 2026 · via Europe PMC
Initial complete local therapy without systemic therapy versus systemic-therapy-based management in selected patients with oligometastatic renal cell carcinoma: a matched comparative study.
Kim HU, Lee HI, Park I, Kim JK, Kim YJ
AI summary — for doctors, generated from the abstract only
In selected patients with oligometastatic renal cell carcinoma, upfront complete local treatment without systemic therapy was associated with better 5-year survival than systemic therapy-based management.
What was studied
Retrospective matched comparison (2015-2023) of 276 oligometastatic RCC patients with up to five lesions, treated with metastasis-directed therapy alone or systemic therapy, with 72 exactly matched pairs.
Key findings
- Five-year overall survival was 73.0% versus 58.6% (HR 0.45) in favor of local therapy alone.
- Cancer-specific survival also favored local therapy (83.7% vs 69.8%), while progression-free and distant metastasis-free survival were similar.
- About 49% of the local-therapy group later started systemic therapy.
Clinical relevance
This supports considering metastasis-directed therapy and delaying systemic treatment in carefully selected oligometastatic RCC, as a possible way to defer drug toxicity.
Who should care
Limitations
Nonrandomized with residual selection bias, small matched cohort, and the systemic arm was mostly TKI-based, so findings do not speak to modern immunotherapy regimens.
Hypothesis-generating only; local therapy alone may suit selected patients but should not replace immunotherapy-based care on this evidence.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
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.
DOI
10.1016/j.radonc.2026.111827
PMID
42869248
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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