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Mansinho et al. J Cancer Metastasis Treat 2021;7:44 https://dx.doi.org/10.20517/2394-4722.2021.88 Page 9 of 12

Table 3. Typical characteristics of BM in renal cell carcinoma
Clinical and pathologic features of renal cell carcinoma BM
· Mostly osteolytic [15]
[29-31]
· High c-MET expression
[76]
· Radioresistant [require high biologically effective dose (BED)]
[80]
· Highly vascularized and destructive
[79]
short-term survival after spinal metastasectomy .

In many cases, treatment goals for patients with BM do not include complete SM, but instead palliative
surgery combined with non-surgical treatment to preserve or restore neurological function and improve
pain control . Spinal metastases can represent a particularly difficult case with regards to symptoms and
[80]
treatment, as neurological pain is often added to nociceptive pain, and neurological impairment can be
observed. Due to close contact with the spinal cord, spinal BM treatment is challenging and requires a
multidisciplinary approach .
[81]

CONCLUSION
BM and SREs increase economic burden and decrease QoL, ultimately increasing morbidity throughout the
metastatic disease course. Additionally, the overall prognosis of these patient is poor, compared with
patients without BM. Advances in systemic and ablative therapy have improved these patients’ outcomes in
recent years. BM in patients with RCC may have a special sensitivity to drugs targeting c-Met, and
administration of BTAs can further improve time to SREs and minimize QoL deterioration. Combining and
sequencing all these resources can be complex, making multidisciplinary intervention of utmost importance
to maximize patient outcomes and treatment.

DECLARATIONS
Acknowledgments
Joana Cavaco Silva is a scientific and biomedical consultant and a senior medical writer for the Medical
Oncology Deparment of CHULN.

Authors’ contributions
Contributed significantly and similarly to the conceptualization, writing and review of the article:
Mansinho A, Nejo P, Leitão T, Casimiro S, Costa L

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Luís Costa has received research grants from Amgen, Bayer, Novartis and Roche, speaker honoraria from
Amgen, Bayer, Janssen, Lilly and Roche, and is also a consultant for Amgen, Novartis and Servier. André
Mansinho has received honoraria as consultant/speaker from Amgen, Astellas, Bayer, Bristol Myers-Squibb,
Janssen, Merck-Serono, Merck Sharp & Dohme, Novartis, OMPharma, Pfizer, Pierre Fabre, Roche, Servier,
Travel/Logistics support from Amgen, Astellas, Bayer, Bristol Myers-Squibb, Janssen, Merck-Serono, Merck
Sharp & Dohme, Novartis, OMPharma, Pfizer, Pierre Fabre, Roche, Servier and Research funding from
Bayer.