Management of oligometastatic and oligoprogressive renal cell carcinoma: an updated review

Introduction: metastasis-directed treatment (MDT) is progressively expanding its scope in the treatment of metastatic renal cell carcinoma (mRCC), finding application both in cases of oligometastatic disease, whether synchronous or metachronous, and in oligo-progression during systemic therapy (ST). This updated narrative review incorporates recent advancements in managing oligometastatic and oligo-progressive RCC. A PubMed literature search using keywords related to mRCC and its treatments was made. Observational studies, clinical trials, and reviews were analyzed, selecting the most relevant articles based on evidence strength. Areas covered: we analyzed the current role of surgery, both on the primary than on metastatic sites, and the recent advantages in both radiotherapy, ST and focal therapies. Lastly, we focused on single metastatic sites of interest. Expert opinion: nowadays personalized tailored treatments are the key, integrating multimodal approaches like metastasectomy, radiotherapy, and ST. While the role of cytoreductive nephrectomy remains debated, metastasectomy and radiotherapy demonstrates potential in managing both oligometastatic and oligo-progressive disease, either alone or in synergy with ST, though more robust evidence is needed. Future research should focus on identifying biomarkers for treatment selection, optimizing therapy timing, and refining patient stratification to enhance outcomes.