Skeletal metastasis in renal cell carcinoma: A review

Abstract

BackgroundRenal cell carcinoma account for 3% of all cancers, with peak incidence between 60 and 70 years of age predominantly affecting male population. Renal carcinoma is the most common malignancy of kidney constitutes for 80–90% of renal neoplasm with an overall 45% five years survival rate. Majority are diagnosed incidentally during investigation for other disease process of abdomen. Classical triad of gross hematuria, pain and palpable mass in abdomen is rare accounting to only 6–10%. Treatment of early stages of disease i.e. localized disease is partial or radical nephrectomy. Most common metastasis in RCC occurs to lung, followed by bone involvement in 20–35%, lymph nodes, liver, adrenal gland and brain. In metastatic disease median survival rate of patient is about eight months with 50% mortality rate within first year of life, five years survival rate is 10%. Skeletal metastasis are very destructive in patients with renal cell carcinoma compromising bone integrity leading to skeletal related events including pains, impending fractures, nerve compressions, hypercalcemia and even pathological fractures which may require surgical interventions and other therapy. In addition to skeletal complications, presence of bone metastases in RCC has negative impact on progression free survival and overall survival of patients treated with systemic therapies.ObjectiveIn this review we discuss pathophysiology of tumor metastasis, diagnosis, management and Case examples of metastatic renal cell carcinoma.ConclusionIncidence of metastatic renal carcinoma is increasing. Overall prognosis of patient with advanced RCC is poor, emphasizing the importance of early detection and prompt treatment of primary lesion in its early stage. Advancement in targeted therapy in recent decades had made some improvement in treatment of SREs and has helped in improving patent's quality of life but still we are in need of further improvement in treatment modalities to cure disease thereby decreasing morbidity and mortality.

Clinical outcomes of 168 Chinese patients after local surgery for bone metastases arising from advanced renal cell carcinoma

“…The clinical outcomes in the current study may provide surgeons with more clinical evidence to assist in evaluating whether to perform local surgery and predicting the subsequent outcomes. In current clinical practice, stratified treatment should be applied using risk models, whereby individualized treatment regimens can be devised on the premise that it is possible to perform comprehensive evaluations of patients' specific conditions …”

“…Approximately one‐third of patients with RCC worldwide ultimately will experience metastatic RCC (mRCC) . Furthermore, the bones are among the most common sites of metastasis; bone metastases (BM) occurs in 20% to 35% of patients with RCC and triggers skeletal‐related events (SREs), which include ostealgia, pathological fracture, spinal cord compression, hypercalcemia, and related conditions …”

“…Systemic therapy is the current standard for patients with mRCC, whereas local management for BM remains controversial. Although to the best of our knowledge radical metastasectomy is the only potentially curative approach and local surgery significantly improves the quality of life (ie, decreases the incidence of SREs and relieves symptoms), the decision to perform surgery for BM depends on a variety of patient‐related features …”

Incidence of bone metastasis and factors contributing to its development and prognosis in newly diagnosed renal cell carcinoma: a population-based study

“…Bone metastasis (BM) has been reported to occur in 20% of metastatic RCC. BM, which leads to the occurrence of skeletal-related events (SREs), can significantly increase morbidity and decrease patients’ quality of life 2,4…”

Low Dosed Curcumin Combined with Visible Light Exposure Inhibits Renal Cell Carcinoma Metastatic Behavior in Vitros

“…At first diagnosis, one third of patients already suffer from lymph node and/or organ metastases [4] with another 20 to 30% developing metastases during therapy [5]. Without treatment, the probability of survival one year after diagnosis of metastasis is only about 50% [6], and the chances of recovery are poor. More than 5000 people died in Germany due to renal cell carcinoma in 2011 [7] and in a disseminated stage only palliative However, due to poor water solubility, low absorption, rapid metabolism and elimination, curcumin has low bioavailability, hampering its clinical use [19,20].…”