Kidney metastases

The definition of "metastasis" has Greek roots - meta stateo, which means "I am different". This accurately characterizes secondary formations of malignant oncological process, since almost 90% of cancerous tumors are accompanied by foci localized not only in regional lymph nodes, but also in organs distant from tumors, most often in the lungs, liver, spine, brain. Metastases in the kidneys are less common, mainly with such oncological processes that are able to give widespread secondary foci. Such tumors include melanoma, lymphoma and bronchogenic carcinoma (bronchogenic carcinoma). Metastasis in the kidney also occurs in cancer of the pharynx, larynx, adrenal tumors, liver, stomach, breast cancer. In 10-12% of cases, the secondary pathological focus in the kidney is formed in cancer of the contralateral (opposite) kidney. The oncoprocess affects the parenchyma and the renal pelvis in various ways - directly by implanting atypical cells from a nearby nearby organ, but most often by hematogenous, lymphogenous, venous or aortic pathways. Renal cell, uterine cancer, nephroblastoma (Wilms tumor) as independent processes are also capable of metastasizing into the lungs, spine, bones, brain and liver. In cancer practice, RCC (renal cell carcinoma) is classified according to the generally accepted TNM system, where the letter M (metastasis, Mts) is the absence or presence of distant metastases.

[1]

Kidney Cancer and Metastasis to the Lungs

The lungs "lead" in the frequency of metastasis in any oncopathology, this is due to the blood supply system, the capillary network of the organ, and also to the fact that it is the lungs that first pass through the whole of the venous blood stream filled with large lymph vessels located in different areas of the body.

In cancer of the kidney, metastases develop according to the cascade principle. In this process the lungs perform the function of the primary barrier, which occurs in the path of malignant atypical cells.

Kidney cancer and lung metastases are the most typical phenomena in this pathology, according to statistics, metastasis to the bronchopulmonary system is about 60-70% of the total number of secondary tumors in RCC. This threatening "preference" is due to the fact that the lungs are a kind of filter for the kidneys whose venous blood enters the bloodstream of the upper and lower vena cava, in contrast to the organs of the gastrointestinal tract that are protected by the liver.

Metastases in the lungs are considered distant secondary foci, patients with similar manifestations are divided into 2 categories: 

1. Cancer of the kidney and metastasis in the lungs are diagnosed on the first visit to the doctor (which is extremely rare).
2. Metastasis to the bronchopulmonary system occurs in a delayed mode, several years after the removal of the primary tumor in the kidney.

The most effective methods of treatment of single metastases in the lungs are surgical treatments, as well as long-term combination therapy. Currently, the secondary focus in this organ is successfully carried out using TT-targeted therapy (target-goal). This is a modern technology for the treatment of metastases, in which antitumor drugs (monoclonal antibodies) of purposeful action are used. Unlike cytostatic therapy, TT accurately neutralizes aggressively multiplying cancer cells in the lungs. Thus, patients with lung metastatic RCC receive not only a hope for life extension, but also a real chance of gradual recovery. Considering that single secondary foci in the lungs have the property of regressing, these chances are increasing.

Kidney cancer and bone metastases

Metastases in bone tissue in kidney cancer occupy the second place in the list of secondary foci development. Kidney cancer and metastases in the bone are diagnosed in 30-35% of patients, the most typical localization is pelvic bone, much less often atypical cells penetrate the bone tissue of the ribs, thighs, spine, only 3% are metastases to the bones of the cranial vault.

How do bone metastases manifest themselves in kidney cancer? 

• Pain when walking (walking), pain, which does not subside with the development of the process and at rest.
• Deformation of the pelvic bones, gait disturbance, asymmetry of the hips.
• Muscle weakness.
• Pathological brittleness of bone tissue, fractures (oncoosteoporosis).
• Hypercalcemia.

When metastasizing into bone tissue, two types of pathology develop:

• Osteolytic foci - leaching, demineralization of bone.
• Osteoblastic secondary foci - thickening of bone tissue, hypercalcemia.

Unfortunately, bone metastases in kidney cancer are detected in the late stages of the process, primary development is most often asymptomatic. The main diagnostic methods that confirm metastasis in bone tissue are survey radiography and scintigraphy. Osteolytic metastases are better seen on X-rays, as they are accompanied by severe hypercalcemia. Osteoplastic foci are more accurately determined with scintigraphy, and X-rays can be a supplement that reveals bone seals and osteosclerotic zones.

Most often metastases in the bone provoke disseminated tumors, in which the secondary foci are spread very quickly. Treatment of such a process is extremely difficult, unlike solitary metastases, which are subject to radical removal and radiation therapy. Multiple foci are subject only to palliative therapy, which can reduce the severity of the symptoms and at least slightly improve the quality of life of the patient. Radiation therapy can also play the role of a kind of analgesic, however, it requires a system, repeated sessions, which are often contraindicated in patients with RCC.

Cancer of the kidney and metastasis in the spine

Metastasis in the vertebral part develops due to penetration into the spine of atypical cells by hematogenous way. Bony lesions begin in the area of the epidural venous plexus, then in the zone through which the malignant cells are entered. Cancer of the kidney and metastases in the spine is evidence of stage III or IV disease, the symptomatology of which is already manifest in full force and provides detailed information for more accurate diagnosis.

The main symptom of metastases in the spine is severe pain, it is noted in 90% of patients. Intensive pain sensations are localized in the affected area, often they are similar to typical radicular pains, but surpass them in strength and frequency. In addition, with advanced RCC stages, visible compression of the spine with characteristic pelvic disorders, tetraplegia (paralysis of all limbs), or paraplegia (in this case paralysis of the lower extremities) is diagnosed in 5% of patients. Tetraparez is accompanied by a systematic muscular spasticy, mainly in the lower limbs (legs), then the arm muscles can join the process. Paraplegia manifests itself with the same symptoms, but it develops faster, most often with a pathological vertebral fracture, characteristic of generalized metastasis. The most typical localization of metastases in the spine in kidney cancer is the sacro-lumbar region when there is an osteoplastic lesion of the zones L2, L3, L4, L5, S1. The zonal frequency of metastases in the spine is distributed in this way: 

• The lumbar zone is 45%.
• Thoracic spine - 25%.
• Sacrum - 30%.

Metastases in the cervical region, the cranial vault in cancer of the kidney are extremely rare, these single cases can not serve as a basis for statistical processing, rather it is evidence of an extremely neglected generalized oncoprocess.

Just as with metastases in bone tissue, secondary foci in the spine are divided into osteolytic and osteoblastic. The symptomatology of them is one in one sign - pain, however, hypercalcemia can also manifest itself with such symptoms that are very important in the sense of early detection of kidney cancer: 

• Constant muscle weakness.
• Neurotic disorders, depression.
• Weight loss, loss of appetite.
• Nausea, rarely vomiting.
• Persistent hypotension.
• Change in the normal heart rate.
• Compression pain.
• Pathological vertebral fractures.

The metastatic clinic in the spinal column is characterized by profound neurological disorders. Loss of limb sensitivity, movement control is formed a few months after the appearance of the first focus, when the spinal cord is subjected to pressure and compression occurs, and then vertebral fracture. Such a late compression symptomatology is caused by the localization of secondary tumors that are formed in the bone substance, and not in the canal. The foci are spreading inside the bone tissue, endophytic way, after which cracks develop, fractures and compression of the roots.

Cancer of the kidney and metastases in the spine are determined by such methods: 

• Anamnesis.
• Inspection.
• Physical examinations.
• Analysis for the level of ALP - alkaline phosphatase.
• Analysis for determining the level of calcium in bone tissue.
• Roentgen of the spine.
• Radioisotope examination - scintigraphy.
• Computed tomography (gold diagnostic standard for determining metastases in bone tissue).
• NMR - nuclear magnetic resonance imaging.

Most often, metastases in the spine are treated with palliative methods, many oncologists consider surgical intervention to be unpromising in terms of effectiveness. The only alternative may be radiosurgery and with the help of the Cyberknife, but not every oncological dispenser has such equipment. Therefore, as a rule, metastasis in the spine is subjected to traditional methods of treatment - radiotherapy, the appointment of corticosteroids, bisphosphonates, immunotherapy, chemoembolization. Pain symptom in vertebral fracture is often anesthetized with Spinal Cord Stimulation - SCS or epidural stimulation with electrodes. This method allows you to supervise the pain syndrome in the pelvic area of the spine and control the degree of rigidity of the muscular system, spasticity.

Metastases in the spine are considered an unfavorable prognostic criterion.

Data, which shows the statistics of the last 15 years, are as follows: 

• Some patients who are diagnosed with kidney cancer and metastases in the spine can move independently. The limited ability to move and motor activity in principle remains in 90% of cases after combined long-term therapy, in 75% of cases after nephrectomy. Life expectancy ranges from 1 year to 1.5 years.
• If the primary tumor lends itself to radiotherapy, development of metastases in the spine can be stopped in 30% of patients, which significantly increases the chances of prolonging survival.
• After radiotherapy, 50% of patients with mild paresis of the legs (paraparesis) retain the ability to move.
• 10-15% of patients with paralysis of the legs (paraplegia) will be able to move after radiotherapy sessions aimed at arresting metastases in the spine.
• Completely immobilized patients have poor prognosis in terms of survival, only 10% of them live just over 1 year.
• In 99% of cases, disruption of pelvic functions becomes irreversible 3-6 months after the appearance of the first metastasis in the spine.

[2], [3], [4], [5], [6]

Cancer of the kidney and metastasis in the brain

Metastasis in the brain is diagnosed 1.5 times more often than the primary oncopathology of the brain. Secondary foci in the brain can give almost all malignant formations, but most often it is noted for lung and breast cancer. Cancer of the kidney and metastases in the brain are diagnosed in 15-20% of the number of all cancers, according to information from other sources their frequency reaches 35%.

The clinical picture of brain metastases will burn different, since before the defeat of the central nervous system, secondary foci first capture the bronchopulmonary system, regional lymph nodes, liver, adrenal glands, bones and contralateral kidney. The process of spreading metastases is inevitably accompanied by a specific symptomatology, against which the signs of Mts (metastasis) of the brain are initially lost. Slow, but constant progression can be interrupted by sudden attacks of a headache - episodes of a spontaneous increase in electrical activity. It is practically impossible to differentiate metastases from the primary brain tumor by clinical signs, since all of them are characteristic for both independent oncopathology and for secondary focal brain damage.

Symptoms that can manifest kidney cancer and metastasis in the brain: 

• ICP is increased, blood pressure may increase "irregular", not amenable to treatment with antihypertensive drugs.
• Attacks of a headache.
• Paresthesia.
• Epileptoid seizures, convulsions.
• Growing cerebellar ataxia (violation of coordination of movements).
• Periodic febrile states.
• Mental instability, hyperlability.
• Violation of cognitive functions.
• Violations of mnemonic functions (memory).
• Noticeable changes in personality traits.
• Asymmetry or different pupil sizes.
• Violations of speech functions.
• Visual dysfunction.
• Nausea, vomiting.
• General weakness.

A gold standard in the diagnosis of brain metastases is neuroimaging, that is, CT scan - computed tomography, which can be performed in various modifications - MRI, MRI with contrast, MRI. Treatment of secondary foci in the brain is carried out mainly by palliative methods, since such complicated tumors have an unfavorable prognosis. Even with complex intensive care, the life span of patients diagnosed with Mts - metastases to the brain does not exceed 7-8 months. Generalized algorithm of therapy, when kidney cancer and metastases to the brain are confirmed by neuroimaging methods:

Clinic	Choice of method of therapy
Focal damage of unknown etiology	Stereotactic biopsy for histological examination and tumor drainage
Disseminated brain metastasis, the Karnovsky scale <70, the apparent negative functional status	Radiation therapy of all brain cells, OBM - whole brain irradiation. Refusal of any method of treatment due to its non-targetedness
Single metastases	Surgical methods - removal, with obligatory radiotherapy LT - radiation therapy and intensive stereotactic radiosurgery (SRX)
Common, multiple metastases with one, the largest, "leading"	Surgical removal, radiotherapy (OBM)
Multiple foci that can not be removed	OBM - whole brain irradiation OBM and CPX

It should be noted that metastases in the brain for any development and degree of prevalence are treated with radiation therapy. In single solitary foci, LT helps to arrest the process, unremovable, multiple metastases are subject to irradiation to reduce pain symptoms. Target therapy with secondary foci of such localization is not applied due to complete inefficiency.

[7], [8], [9], [10], [11]

Kidney Cancer and Metastasis in the Liver

Malignant tumors can spread their atypical cells to regional zones, as well as to distant organs. Most often this occurs most accessible way - hematogenous, possibly metastasizing through the lymphatic vessels, less common is the germination of malignant cells directly from the affected organ to the neighboring one. Cancer of the kidney and metastases in the liver are diagnosed extremely rarely, according to various information, this occurs in 2-7% of patients. The liver is affected by the characteristics of its circulatory system. It is known that the main role of the liver in the body is detoxification, for which increased blood flow activity is required. Blood enters the organ along the main artery, using the portal system (portal vein). For 1 minute, the liver is able to process up to 1.5 liters of incoming blood, about two-thirds of the bloodstream enters the liver from the intestine. Such active work with blood creates a favorable background for the penetration of malignant structures into the liver. It should be noted the feature of hematogenic foci in the liver, which are formed regardless of the relationship of the primary tumor with the portal system. Obviously, this is due to the main detoxification function of the body, which absorbs everything that is in the bloodstream.

Clinic of metastases in the liver is characterized by an asymptomatic course of the process in the initial stages. Atypical cells slowly, but systematically replace the hepatic tissue, provoking its dysfunction. At random biochemical examinations, the level of fermentation (AST, ALT) is noted in the analyzes, in the stage of active foci development, most often in III and IV, symptoms of massive intoxication, jaundice can be noted. Clinical manifestations of developed metastases are as follows: 

• Constant feeling of fatigue.
• A steady decrease in body weight.
• Feeling of heaviness in the right hypochondrium, in the upper abdominal zone.
• Attacks of dull pain in the abdomen, similar to signs of obstruction of the bile ducts.
• Increased sweating.
• Subfebrile temperature.
• Itching itch.
• Periodic attacks of tachycardia.
• An increase in the abdomen - ascites indicates the involvement of the peritoneum in metastasis, as well as thrombosis of the portal system.
• If the metastases are formed as dense nodes, there may be some kind of cavities on the surface of the abdomen (an umbilical entrainment).
• Due to the fact that the blood flow is strongly slowed due to the development of secondary foci, there is no arterial noise during percussion.
• Splenomegaly indicates the neglect of the pathological process.
• The yellowness of the skin, of the eye proteins can serve as a sign of the invasion of atypical cells into the bile ducts. This symptom is extremely rare.

In the diagnosis of secondary focal lesions of the liver, the leading position is still occupied by methods of neuroimaging - CT, MRI. Ultrasound scanning in this case is not informative, and computer tomography is able to show the state of liver tissue, multidimensional tumor parameters and its metastasis.

Cancer of the kidney and metastasis in the liver are considered a serious oncological disease with an unfavorable prognosis. Systemic therapeutic measures can only give results in the first two stages of the process, a combination of chemotherapy and hormonal therapy slows down the development of secondary foci somewhat. Surgical treatment is shown only with single metastases, this makes it possible to improve the patient's quality of life and prolong his life. The expediency of the operation is determined by the oncologist depending on the size, localization of the primary tumor and its secondary formations. Often, surgical methods are contraindicated because they carry anesthetic risks, especially in stages III and IV of kidney cancer. A triggered oncology process can only be supervised by a nephroectomy, provided the patient's condition is relatively normal. The use of cytostatics is effective only in the initial stage of tumor formation and metastases, intensive chemotherapy in combination with radiation therapy is aimed at reducing the size of the foci and preventing the appearance of new ones in nearby areas. A good effect is provided by systemic therapy, which includes cytotoxic drugs, targeted therapy and embolization of the vessels that nourish the diagnosed metastases. Chemotherapy in the treatment of multiple liver metastases is not used, and the subsequent interferon therapy or a combination of interferons and interleukins helps to reduce pain symptoms and increase the life expectancy of the patient.

Symptoms of metastasis in the kidneys

Specificity of metastasis in RCC (renal cell carcinoma) is that the clinical manifestations most often indicate the III or IV stage of the process. The initial development of secondary foci, wherever they are localized, is characterized by asymptomatic behavior, which greatly complicates treatment and burdens the prognosis of the disease. More than a quarter of patients who are diagnosed with kidney cancer for the first time already have metastases in regional lymph nodes or distant organs.

In general, the symptoms of kidney metastases have the specificity of the affected area (organ) and can be such: 

• Metastases in the lungs: 
  • Constant dyspnea.
  • Frequent cough, worse at night.
  • Feeling of heaviness, stiffness in the chest.
  • The presence of blood in the mucus when coughing, hemoptysis.
• Cancer of the kidney and metastasis in the bone:
  • Localized bone pain in the spine.
  • Gradual increase in lethargy, fatigue.
  • Steady limitation of motor activity.
  • Pathological fractures.
  • Numbness of the lower extremities.
  • Compression pain.
  • Lower paraplegia (paralysis of the legs).
  • Complete immobilization.
  • Dysfunction of the bladder is possible.
  • Hypercalcemia - nausea, weight loss, hypotension, depression, dehydration.
• Metastases in the brain: 
  • Ataxia.
  • Dizziness.
  • Headache (attacks on the type of migraine).
  • Reduction of cognitive functions - memory, speech, thinking.
  • Depression.
  • Change in personality traits, mental disorders.
  • Asymmetry of the face.
  • Different sizes of eyes, pupils.
  • Nausea, vomiting.
  • Fatigue, persistent drowsiness.

The general symptomatology of metastasis is characterized by a decrease in the level of hemoglobin (anemia), an increase in ESR, a subfebrile temperature, an increase or decrease in blood pressure, a decrease in body weight (blastomatous process), severe pain both in the site of localization of metastases and in remote areas.

Metastasis of kidney cancer

Metastases of the oncological process in the kidney account for more than half of the clinical signs of cancer and are diagnosed in 45-60% of patients. Unfortunately, the presence of metastases indicates a neglected stage of cancer, when secondary foci are considered more severe pathology than the primary tumor. Metastasis affects many organs, the localization of secondary foci by frequency is statistically determined in this way: 

• lungs,
• The lymph nodes,
• pelvic bones,
• spine,
• costal-clavicular space,
• bones of the cranial vault,
• liver,
• adrenal glands,
• contralateral kidney,
• brain.

Metastases in the lungs account for about 45% of all secondary foci in kidney cancer, this is due to the anatomical location of the organs and their venous connection. The venous renal system as well as the major vessels of the thorax closely interact, so the proliferation of atypical malignant cells is almost inevitable primarily in the bronchopulmonary system.

The most closely located cancer metastases in the kidneys are located in the lymph nodes - para-aortic, located along the aorta, and in the retroperitoneal, paracaval nodes. Lymph nodes of the neck, mediastinum, inguinal nodes are much less affected, local metastases can occur in the pericardial layer of the cellulose or in postoperative scars, such cases are diagnosed in 25% of patients who have undergone nephroectomy.

Metastasis as a process occurs, primarily, by hematogenous pathway - to distant organs, the lymphogenous pathway is considered the most unfavorable when the regional lymph nodes are extensively affected.

It should be noted that the peculiarity of metastasis in RCC is the delayed manifestation of clinical signs of secondary foci. Sometimes metastases can be detected 10 years after the removal of primary education in stage I. In this case, secondary foci develop less aggressively and are treated more successfully. In addition, there is one more characteristic feature, single lung metastases can regress independently, especially after a timely nephrectomy at the initial stage of the oncology process. In this regard, an important role is played by the accurate diagnosis of kidney cancer, since its earlier detection can significantly increase the life expectancy of the patient.

Diagnosis of kidney metastases

A standardized, universal regimen for determining secondary metastatic tumors in RCC does not exist, since kidney cancer is divided into species, stages according to the international classification, and each variant requires an individual approach to the choice of diagnostic methods. Diagnosis of metastases in the kidneys is difficult in principle due to late manifestations of clinical symptoms, when it is sometimes impossible to separate the sign of the primary tumor from manifestations of secondary foci. The regional metastases localized in the lymph nodes are most easily determined. The distant organs, which are affected by atypical cells by the hematogenous pathway, do not always clearly demonstrate metastatic foci, especially in the initial stage of the process. Nevertheless, we consider it possible to give as an example such methods of diagnostic actions in the search for distant foci in RCC:

Radiography, radiography	Serum Analyzes	Ultrasonography	Neuroimaging
X-rays of light	Determination of alkaline phosphatase, ALaT, ASAT	Kidney ultrasound	CT scan - computed tomography (brain, bone system, liver)
Chest x-ray, mediastinum	Hepatic tests	Ultrasound of the abdominal cavity organs	MRI - magnetic resonance imaging (brain, liver, skeleton)
Roentgen of the abdominal cavity	The determination of the level of calcium and LDH (lactate dehydrogenase)	Ultrasound of the heart (according to the indications in the advanced stages of the process)
Radioisotope renography (X-ray of the kidney)	Oncomarkers	Ultrasound of regional lymph nodes

Also informative is scintigraphy, showing the slightest structural changes in the bone system and angiography determining the state of the vascular system feeding secondary foci.

Diagnosis of metastases in the kidneys is most often performed according to the "gold" standard in practical oncology - using computed tomography, which allows you to clearly see the state of the organs of the abdominal cavity, pelvic organs, chest, lungs, bone system and brain. Many variants of images allow the physician to make an objective clinical picture of the disease and choose the right therapeutic direction, to decide on the extent and effectiveness of surgical intervention. CT is performed in contrast and conventional methods, the contrast gives more informative pictures, the advisability of contrast CT is determined by the oncologist-diagnostician. MRI is more often used when there is a suspicion of brain metastases, as well as CT scan, this method provides an objective visual "description" of the patient's neurological status.

In the diagnosis of secondary foci, cytological methods of urinalysis, biopsy (including fine-needle), urethroscopy, and coagulogram can be used. One of the latest analytical achievements in practical oncology is the method of immunodiffusion study, which determines the deep metabolic dysfunction, changes in the level of serum proteins, albumin, ferritin, trnasferrin. Immunological method of diagnosis is carried out in different ways: 

• Reaction of radial immunodiffusion.
• Immunoelectrophoresis.
• Double immunodiffusion.
• Counter immunophoresis.

Currently, immunological analysis is one of the most effective in the early diagnosis of both the primary tumor of the kidney and its secondary foci, this allows to identify the cancer at the very beginning of development and significantly improves the prognosis in terms of the duration of life and the period of remission after complex treatment.

[12], [13], [14], [15], [16], [17],

Treatment of metastases in the kidneys

Therapeutic measures in cancer of the kidney with metastases always presents a huge problem, since such a stage of the process is poorly supervised by chemotherapy, and radiation therapy is considered not effective in principle. RCC (renal cell carcinoma) is very resistant to cytostatics due to the aggressiveness of the glycoprotein of tumor cells (P-170), which rapidly removes cytotoxic substances and their metabolites, preventing their impact. According to the data of long-term clinical trials, the effectiveness of chemotherapy with metastatic kidney cancer is only 4-5%. However, cytostatic therapy is still prescribed as a possible method, especially since the latest pharmacological developments give hope to increase the effectiveness of new drugs when exposed to atypical cells. Currently, treatment of metastases in the kidney can be carried out with the help of pyrimidines of a new generation. The drug Xeloda (Capecitabine) helps to reduce the severity of symptoms and achieve a one-year remission in 9% of patients. Also approved for use Nexavar, Torisel, Sutent, Sunitinib, Sorafenib - targeted therapy.

In the treatment of secondary foci in the kidney cancer an important role is played by immunotherapy, which is divided into the following types: 

1. Nonspecific interleukinovaya or interferonovaya therapy, as well as therapy using other ICBM - modifiers of biological reactions.
2. Therapy using ALT - autolymphocytes, LAK - lymphokine - activated killers, TIL - tumor - filtering lymphocytes. Adaptive-cellular immunotherapy.
3. Immunotherapy with the use of monoclonal antibodies. Specific therapy.
4. Gene immunotherapy.

Treatment of metastases in the kidneys involves the appointment of drugs of the interferon group, interleukins: 

• Reaferon.
• Nitron-A.
• Roferon.
• Velferon.
• Proleukin.
• Interleukin-2.

The combination of cytostatics and cytokines allows regression of the tumor in 30% of patients, provided that metastases are characterized as single, small and localized in the lungs. When metastasizing to the bone system and the brain, interferon therapy is not effective, since this stage is in principle unfavorable in the prognostic sense for any kind of therapy. The effectiveness of immunotherapy does not appear immediately, sometimes it is necessary to wait for 3-4 months, but treatment should be permanent, systematic and continuous, even after receiving the effect.

One of the new methods of treatment of metastatic RCC is allogeneic transplantation with embryonic stem cells. This type of therapy is only part of oncology practice and its effectiveness is not yet clear, although some sources say that a positive response to transplantation is about 50%.

Radiation therapy in renal cell carcinoma is considered ineffective, atypical cells are resistant to radiotherapy, but it is used as a palliative method to reduce the severity of pain symptoms and some improvement in the patient's quality of life. In addition, RT (radiation therapy) helps to stabilize the bone system when metastasizing to the bone and prevent tissue remineralization.

In general, kidney metastases are still treated surgically, if their localization does not interfere with the operation. Surgical intervention remains the most effective method in the treatment of metastatic RCC as a means to neutralize the focus of the process and is carried out in such ways: •

• Resection, depending on the prevalence of the process may be open or laparoscopic.
• Removal of the tumor together with the organ - nephrectomy.
• Cryoblastic malignant education under the supervision of ultrasound.
• Chemoembolization.
• Radiosurgery.

It should be noted that those oncological centers that are equipped with a robotic cybernetic hardware complex give 2 times more chances for survival to their patients. It is especially effective to perform a radiosurgical operation at stage I, II stage of renal cell carcinoma, even in the presence of metastases. Cyberknife can neutralize virtually any hard-to-reach tumor, the mechanism of action is a powerful beam ionizing radiation, which destroys all atypical cells. Radiosurgery is characterized not only by high accuracy and low-traumatic effect during manipulations, but also by the fact that when the affected tissues are neutralized, the healthy zones remain intact and intact. If the operation is not possible due to the patient's serious condition and neglect of the disease, such treatment methods are shown: 

1. Target therapy as one of the new methods for inoperable metastatic kidney cancer.
2. Symptomatic palliative treatment - with widespread metastasis.

Kidney metastases are considered to be an adverse event, and the prognosis of treatment directly depends on their number, localization of secondary foci. According to statistics, the average five-year life expectancy is observed in 40% of patients after nephrectomy and comprehensive, long-term treatment. A much smaller percentage of patients survive in stages III and IV, but medical science does not stand still. Literally every year, there are new more advanced drugs, methods of treatment, this gives hope that the cancer will cease to be a terrible sentence and will be defeated.