Renal Carcinoma

Although renal cell carcinoma (RCC) is relatively rare compared to lung, breast or prostate cancer, it is an aggressive malignancy that frequently metastasizes. The approximately 30,000 cases of renal cell carcinoma account for only 2.5% of all cancer patients. However, as many as 50% of these patients will have evidence of metastatic disease at the time of diagnosis [25]. Although metastatic renal cell carcinoma is found in multiple organs, there is a disproportionately high number of metastases to the spine, making it the fourth most common cancer to affect the spine, and the most common type to present with a neurological deficit as an initial presentation [25].

In contrast with breast and prostate cancer, however, the majority of RCCs are highly resistant to systemic chemotherapy and radiation therapy. In a minority of patients, immunotherapy such as interferon- or interleukin-2 will show a partial response. Therefore, at many institutions, surgery is considered to be the primary treatment option.

Surgery is most often indicated in patients with severe, medically intractable pain, neurological deficit or spinal instability. Classically, RCC is richly vascularized in comparison to other metastatic tumors of the spine. Therefore, many patients undergo pre-operative tumor angiography and embolization to minimize the degree of blood loss during surgery. Although the effectiveness of pre-operative embolization has been debated, it is typically performed prior to non-emergent surgery in patients with large tumors.

Due to the absence of effective systemic therapy, the prognosis of metastatic RCC remains poor, with less than 15% survival at 5 years. Surgical resection and stabilization can provide effective pain relief and neurological preservation or improvement, and the goal of therapy is palliation and prevention of neurological deficits, rather than increase in length of survival [2,14,15,17-19,25].

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