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In the European Union 60,000 patients are diagnosed annually with renal-cell carcinoma (RCC) [1]. Synchronous metastases are present in up to 30% of patients, with multiple sites affected in 95% [2,3]. Since an additional 40% of those undergoing surgery for localised RCC develop metachronous metastasis, approximately 30,000 patients per year are diagnosed with systemic disease, of which an estimated 7000 have non-clear-cell histology.  In a recent population-based analysis, lung metastasis was most frequent at 45.2%, followed by bone at 29.5%, lymph nodes at 21.8% and liver at 20.3% [4]. Adrenal, brain and other locations had a lower frequency. Moreover, it was found that the proportion of patients with multiple metastatic sites was higher in young patients, 16% and 49% of which had brain and bone metastasis, respectively [4].

Integrating metastasectomy and stereotactic radiosurgery in the treatment of metastatic renal cell carcinoma