Combination of systemic and surgical treatment in a patient with primarily inoperable renal cell carcinoma in a horseshoe kidney: the importance of multidisciplinary collaboration – updated results of 3-year follow-up

Czech version

Authors: Jiří Herman ¹; Vladimír Študent jr. ¹; Aleš Vidlář ¹; Anežka Zemánková ²; Igor Hartmann ¹
Authors‘ workplace: Urologická klinika LF UP a FN Olomouc ¹; Onkologická klinika LF UP a FN Olomouc ²
Published in: Ces Urol 2026; 30(1): 30-34
Category: Case report
doi: https://doi.org/10.48095/cccu2026004

Overview

Primarily inoperable, locally advanced renal cell carcinoma represents a significant challenge in uro-oncology. Although systemic therapy is not a standard component of treatment in this setting, in carefully selected patients it may lead to disease regression and enable subsequent surgical resection. We present updated results of a 3-year follow-up of a patient with an initially inoperable finding in whom systemic therapy created the conditions for a subsequent successful surgical intervention.

Keywords:

renal cell carcinoma – systemic therapy – regression – surgical management

Sources

1. Bray F, Laversanne M, Sung H et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024; 74(3): 229–263. doi: 10.3322/caac.21834.

2. International Agency for Research on Cancer. GLOBOCAN 2020: Cancer today –⁠ kidney cancer internet. Lyon: IARC 2020. [online]. Available from: https://gco.iarc.who.int/today/data/factsheets/cancers/29-Kidney-fact-sheet.pdf.

3. EAU Guidelines. Edn. presented at the EAU EAU Guidelines, Madrid 2025. [online]. Available from: https://uroweb.org/guidelines/renal-cell-carcinoma.

4. Bindayi A, Hamilton ZA, McDonald ML et al. Neoadjuvant therapy for localized and locally advanced renal cell carcinoma. Urol Oncol 2018; 36(1): 31–37. doi: 10.1016/j.urolonc.2017.07.015.

5. Zemankova A, Studentova H, Kopova A et al. Neoadjuvant nivolumab and cabozantinib in advanced renal cell carcinoma in a horseshoe kidney –⁠ how to achieve a safe and radical resection? A case report and review of the literature. Front Oncol 2023; 13 : 1115901. doi: 10.3389/fonc.2023.1115901.

6. Bilen MA, Jiang JF, Jansen CS et al. Neoadjuvant cabozantinib in an unresectable locally advanced renal cell carcinoma patient leads to downsizing of tumor enabling surgical resection: a case report. Front Oncol 2021; 10 : 622134. doi: 10.3389/fonc.2020.622134.

7. Roy AM, Briggler A, Tippit D et al. Neoadjuvant cabozantinib in renal-cell carcinoma: a brief review. Clin Genitourin Cancer 2020; 18(6): e688–e691. doi: 10.1016/j.clgc.2020.04.003.

8. Ingels A, Campi R, Capitanio U et al. Complementary roles of surgery and systemic treatment in clear cell renal cell carcinoma. Nat Rev Urol 2022; 19(7): 391–418. doi: 10.1038/s41585-022-00592-3.

9. Roussel E, Tasso G, Campi R et al. Surgical management and outcomes of renal tumors arising from horseshoe kidneys: results from an international multicenter collaboration. Eur Urol 2021; 79(1): 133–140. doi: 10.1016/j.eururo.2020.09.012.

10. European Association of Urology. EAU Guidelines on Renal Cell Carcinoma 2024. [online]. Available from: https://uroweb.org/guidelines/renal-cell-carcinoma.

11. Bex A, Jewett M, Lewis B et al. A call for a neoadjuvant kidney cancer consortium: lessons learned from other cancer types. Eur Urol 2025; 87(4): 385–389. doi: 10.1016/j.eururo.2025.01.007.

12. Allaf ME, Kim SE, Master V et al. Perioperative nivolumab versus observation in patients with renal cell carcinoma undergoing nephrectomy (PROSPER ECOG-ACRIN EA8143): an open-label, randomised, phase 3 study. Lancet Oncol 2024; 25(8): 1038–1052. doi: 10.1016/S1470-2045(24)00211-0.

13. Motzer RJ, Rini BI, McDermott DF et al. Nivolumab plus ipilimumab versus sunitinib in first-line treatment for advanced renal cell carcinoma: extended follow-up of efficacy and safety results from a randomised, controlled, phase 3 trial. Lancet Oncol 2019; 20(10): 1370–1385. doi: 10.1016/S1470-2045(19)30413-9.