**Author details**

evaluated. Results of prospective randomized trials for example CARMENA study ("Clini‐

With regard to the surgical treatment of metastasis themselves this indication must be made primarily in response to the location, size and extent of metastasis findings, the symptoms

Solitary pulmonary filiae should be checked for resectability. Are there only a few (up to three) localized metastasis, then a nephrectomy plus complete resection of metastasis can lead to a significant survival benefit. Basically patients with synchronous pulmonary meta‐ stasis have a significant worse prognosis than those with a metachronous metastasis. If it is a disseminated metastasis the initiation of a targeted therapy for (long-term) stabilization of the disease should be discussed with the patient. The basis for this inhibition of tumour growth is a modification of growth signaling inside the tumour cell and the (neo)angiogene‐ sis. Currently seven substances (in different indications) are available: tyrosine kinase inhib‐ itors such as sunitinib, sorafenib, pazopanib and axitinib, antibody-based therapies such as bevacizumab plus interferon-alpha and mTOR ("mamillian target of Rapamycin") inhibitors as temsirolimus and everolimus. The use of drugs in the adjuvant setting with advanced re‐ nal cell carcinoma with a high risk of disease progression is currently being evaluated in

In case of hepatic filiae with a median survival rate of 6-18 months the indication for resec‐ tion in case of a solitary metastasis with a diameter <5 cm should be evaluated if liver func‐ tion is intact. It is essential to inform the patient about this procedure`s high morbidity. For non-resectable liver metastasis it is possible to perform a CT-guided percutaneous radiofre‐

In the detection of brain metastasis a surgical approach is to be discussed especially with the onset of neurological symptoms. The indication for resection of metastasis through stereo‐ tactic radiosurgery (GammaKnife, CyberKnife) or radiation therapy is to be weighed indi‐ vidually. When limited in size and number of brain metastasis very good results can be

An indication for surgery in bone metastasis may present neurological deficits in a myelon compression, pain, and fracture risk in instability of the bone. However survival time exten‐

Metachronous adrenal metastasis without evidence of further metastasis should be surgical‐

Surgical therapy remains the only curative approach in the treatment of renal cell carcinoma being resistant opposite radiation and chemotherapy. (Radical) nephrectomy was the stand‐ ard surgical procedure over a long period of time. The spread and further developments of

achieved in this case with regard to the local control of metastasis.

sions are described in an osseous metastasis only in individual cases.

cal Trial to Assess the Importance of Nephrectomy") are still pending.

and the overall situation of the affected patients.

quency induced thermal ablation (RITA).

clinical trials.

82 Renal Tumor

ly removed.

**6. Conclusion**

Carolin Eva Hach\* , Stefan Siemer and Stephan Buse

\*Address all correspondence to: carolin.hach@krupp-krankenhaus.de

1 Department of Urology, Alfried Krupp Hospital, Essen, Germany

2 Department of Urology, Saarland University, Homburg/Saar, Germany
