PULMONARY METASTASES FROM RENAL CELL CARCINOMA: CLINICAL FEATURES AND THERAPEUTIC MANAGEMENT

Renal cell carcinoma (RCC) is characterized by a high metastatic potential, with the lung representing the most frequent site of dissemination in patients with advanced disease. Pulmonary metastases play a central role in prognostic assessment and therapeutic decision-making. Over the past decade, major advances in immunotherapy and targeted therapies have profoundly transformed the management of metastatic RCC. This narrative review provides an overview of the biological behavior, clinical presentation, prognostic implications, and therapeutic management of pulmonary metastases from RCC. Available evidence suggests that pulmonary metastases exhibit distinct clinical characteristics, including enhanced sensitivity to immunotherapy-based combinations compared with other visceral metastatic sites. Immunotherapy tyrosine kinase inhibitor combinations and dual immune checkpoint blockade now constitute the cornerstone of first-line treatment. In selected patients with lung-dominant oligometastatic disease, the integration of local treatment strategies such as pulmonary metastasectomy or stereotactic body radiotherapy may result in prolonged disease control. Multidisciplinary and individualized management remains essential to optimize clinical outcomes.