Despite advanced in systemic therapy for renal cell carcinoma (RCC), bone metastasis remains an adverse prognostic factor and major cause of mortality and morbidity. Orthopedic interventions may provide symptom relief, functional recovery, and survival benefit, yet the evidence is fragmented across heterogeneous studies.
To systematically review the outcomes of orthopedic surgical interventions in patients with symptomatic bone metastases from RCC.
Systematic literature review conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
A comprehensive search of Embase, MEDLINE, and the Cochrane Library was conducted for studies published between January 1, 2014, and January 30, 2024. Eligible studies included randomized controlled trials, prospective observational studies, and retrospective studies reporting on orthopedic interventions for RCC bone metastases. Primary outcomes included overall survival, reoperation rates, complication rates, and quality of life.
Of 2208 studies screened, 15 met the inclusion criteria. All were retrospective series or case series, limiting the strength of the evidence. Six studies focused on appendicular skeleton metastases, five on axial skeleton involvement, and four on both regions. Results were primarily reported narratively, with limited statistical analyses. Orthopedic surgical interventions-particularly when combined with targeted systemic therapy-were associated with longer overall survival. Among surgical approaches, complete metastasectomy was most consistently associated with improved survival compared with intralesional curettage and stabilization-only procedures.
Although available data suggest that orthopedic surgery, particularly complete metastasectomy, may improve overall survival and quality of life in RCC patients with bone metastases, the evidence is limited to retrospective and narrative reports. Some studies also suggest that outcomes may be further enhanced when surgery is integrated with systemic therapy. Given the poor prognosis associated with bone involvement in RCC, prospective randomized studies are urgently needed to define optimal patient selection, standardize management strategies, and integrate surgery with systemic therapy in a multidisciplinary framework.
Bone surgery and treatment results in people with kidney cancer that has spread to the bones: a summary of research studies Why we did this study: Renal cell carcinoma (RCC) is a type of kidney cancer that can spread to the bones, causing pain and reducing quality of life. Given the fact that treatments for RCC have improved, patients are living longer, which means that managing bone-related complications has become more challenging and important. We wanted to find out whether orthopedic surgery helps patients with bone metastases from RCC live longer or feel better compared to other treatments like radiation or medications. What we did: We reviewed and analyzed research studies published between 2014 and 2024 that looked at treatments for RCC patients with bone metastases. We focused on comparing orthopedic surgery, particularly surgeries that remove cancer from the bone to other approaches like radiation therapy, medications, or simpler bone stabilization procedures. We looked at outcomes such as survival, complications, the need for further surgery, and quality of life. What we found: Out of more than 2,000 studies, we included 15 in our review. We found that patients who had surgery to completely remove bone tumors (called complete metastasectomy) tended to live longer than those who had less aggressive procedures or non-surgical treatments. Combining surgery with targeted cancer drugs may offer even more benefit. Radiation therapy may help in some cases; however, the evidence is limited. Most of the studies found were not randomized trials, which means the results are not definitive. What this means: Orthopedic surgery, particularly when combined with other treatment, can help some patients with RCC that have spread to the bones live longer and improve their quality of life. However, more high-quality studies are needed to confirm these benefits and to help doctors decide which patients will benefit the most from surgery.
Therapeutic advances in medical oncology. 2025 Oct 15*** epublish ***
Abdulrahman Al Bochi, Mohamad Tarek Madani, Muhammad El-Kassem, Mohammed Fadel, Adnan Rajeh, Gabriel Boldt, Ricardo Fernandes
Schulich School of Medicine and Dentistry, Western University, London, ON, Canada., Verspeeten Family Cancer Centre, Victoria Hospital, London Health Sciences Centre, London, ON, Canada., Division of Experimental Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada., Department of Oncology, London Health Sciences Centre, Western University, 800 Commissioners Road East, Room A3-940, London, ON N6A 5W9, Canada.