Management of Advanced Renal Cell Carcinoma

The treatment landscape for advanced renal cell carcinoma (RCC) has rapidly evolved with the emergence of immune checkpoint inhibitors, targeted therapies, and combination systemic regimens. These advances have improved outcomes while simultaneously redefining the role of surgery. Cytoreductive nephrectomy, metastasectomy, and resection of locally advanced disease are increasingly considered within individualized, multimodal treatment strategies rather than as routine interventions. Important questions remain regarding patient selection and timing of surgery, the role of nephrectomy following systemic therapy, the significance of pathologic response, and management of oligometastatic disease and venous tumor thrombus as well as role of radiation. Radiation has emerged as an important local treatment modality, particularly for patients with oligometastatic or oligoprogressive disease and for palliation of symptomatic metastatic sites. A contemporary understanding of how systemic and local therapies should be integrated is therefore essential. This collection will provide a multidisciplinary overview of current evidence, emerging strategies, and controversies in the medical and surgical management of advanced RCC.

This collection aims to provide a comprehensive and contemporary assessment of the evolving management of advanced RCC, with particular emphasis on integrating systemic and surgical therapies. We will highlight current evidence regarding cytoreductive nephrectomy, surgery following immunotherapy, management of tumor thrombus and oligometastatic disease, minimally invasive approaches and role of radiation. The collection will also examine emerging concepts including treatment response, pathologic response, biomarkers, and response-guided decision-making. By bringing together experts in urologic oncology, medical oncology, radiation oncology, radiology, pathology, and translational research, we aim to address areas of ongoing controversy and identify important unanswered questions. Ultimately, this collection seeks to provide clinicians and researchers with practical, evidence-based perspectives while highlighting future directions for individualized, multidisciplinary treatment of patients with advanced RCC.

We welcome Original Research, Systematic Review, and Narrative Review articles on themes including but not limited to:

• Contemporary and Novel Systemic Therapies for Advanced RCC
• Cytoreductive Surgery Following Systemic Therapies in the Modern Era
• Locally Advanced RCC and Tumor Thrombus
• Management of Treatment-Resistant and Refractory RCC
• Treatment of advanced non-clear cell RCC
• Role of radiation in advanced RCC
• Minimally Invasive and Advanced Surgical Approaches: robotic nephrectomy, robotic IVC thrombectomy, surgical reconstruction and multidisciplinary operative approaches
• Future Directions and Unanswered Questions: biomarkers, AI, ongoing clinical trials