Renal cell carcinoma (RCC) is a malignant neoplasm arising from the epithelial cells of the renal tubules. Accounting for approximately 85% of all malignant renal tumors, it is the most common form of kidney cancer and represents around 2–3% of all solid malignancies in adults.
In Germany, approximately 15,000 people are newly diagnosed with renal cell carcinoma each year. Men are affected approximately twice as often as women. Peak incidence occurs between 60 and 75 years of age.
As abdominal ultrasonography and cross-sectional imaging have become widely available, more than 50% of renal cell carcinomas are now detected incidentally at an early, asymptomatic stage. This has substantially broadened the available treatment options.
Approximately 30% of renal cell carcinomas are not diagnosed until metastatic disease is already present. A further 20–30% of patients who initially undergo surgery for localized disease subsequently develop distant metastases, most commonly in the lungs, bones, liver, adrenal glands, and brain.
Because diagnostic imaging is now widely used, renal cell carcinoma is frequently detected in asymptomatic patients. Clinical manifestations usually develop only once the tumor is more advanced.
The classical triad of hematuria, flank pain, and a palpable renal mass is now regarded as a late manifestation and is present in only approximately 6–10% of patients.
Renal cell carcinoma is associated with a broad spectrum of paraneoplastic syndromes resulting from tumor-related hormone and cytokine production.
The diagnosis of renal cell carcinoma is based on imaging and laboratory investigations. Biopsy is indicated in selected situations but is not routinely required.
In addition, the anatomical extent of the tumor is assessed using the TNM classification (simplified).
Treatment decisions in renal cell carcinoma are made on an interdisciplinary basis and depend on tumor stage, histological subtype, the patient's general condition, and the function of the contralateral kidney.
| Criterion | Surgery | CyberKnife |
|---|---|---|
| Tumour size | Large tumours can also be treated | Small to medium (up to approximately 5 cm) |
| Location | Surgically accessible | Also suitable for centrally located tumours or tumours previously treated surgically |
| Symptoms | Good general health; medically fit for surgery | Also suitable for patients with limited fitness for surgery or pre-existing medical conditions |
| Treatment goal | Tumour removal | Tumour growth control |
| Hospital admission | Required | Not required |
| Treatment duration | Surgery lasting several hours | Approximately 20-30 minutes |
| Long-term tumour control | 95% | 90% |
| Return to normal daily activities | Recovery over several weeks | Immediately |
In contrast to conventional surgery, CyberKnife® treatment is performed on an outpatient basis. The robotically guided system delivers radiation to the tumor from multiple beam directions with submillimeter precision. This permits a steep dose gradient: a high radiation dose is concentrated within the tumor, while the dose decreases rapidly in the surrounding healthy tissue. Treatment is delivered with highly precise target localization, allowing adjacent organs and surrounding normal tissues to be selectively spared. Whereas conventional radiotherapy may require a prolonged
course of treatment, CyberKnife® treatment can be completed in only a few sessions. This reduces treatment burden and may improve comfort, quality of life, the ability to maintain normal daily activities, and overall tolerability. As the treatment is non-invasive, it avoids the surgical and anesthesia-related risks associated with an operative procedure.
Many patients can resume their usual daily activities immediately after treatment.
At the ERCM, patients have been successfully treated with radiosurgical techniques for more than 20 years.
Left: In this case, a 72-year-old male patient with right-sided renal cell carcinoma underwent radiosurgical treatment in June 2024.
Right: Five months after a single CyberKnife® treatment session (treatment duration: 30 minutes), MRI demonstrated a marked reduction in tumor volume of approximately 80%, indicating a pronounced local treatment response. Follow-up imaging can now be performed at annual intervals.
Renal cell carcinoma is a potentially serious malignancy, particularly if it is not detected and treated at an
early stage. Prognosis depends on the stage and extent of the tumor.
Approximately 70% of renal cell carcinomas are asymptomatic and are detected incidentally on renal ultrasonography. Symptoms generally occur only at more advanced stages. Common manifestations include hematuria, pain, a palpable renal mass, and weight loss. When Can Renal Cell Carcinoma Be Treated with Radiosurgery? Robotically guided, high-precision CyberKnife® treatment may be considered—depending on the size and location of the tumor—when surgery is not desired or when the operative risk is considered too high.
Renal cell carcinoma may recur even after successful treatment. The individual risk of recurrence varies and depends on the type and stage of the original tumor, the effectiveness of treatment, and the patient's other medical conditions. Regular follow-up is therefore essential, as it enables recurrent disease to be detected and treated.
Yes. The most common sites of metastatic spread in renal cell carcinoma are the lungs, liver, bones, and brain.
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