Six percent of cases with renal cell carcinoma (RCC) can present with thrombus, and also invasion to renal vein, and atrium may be observed in 44% and 1-4 % of these cases, respectively. These cases require multidisciplinary management and surgery should be the first treatment option. However, if a tumor is considered unresectable or metastatic, systemic therapy can be considered in the first instance. Herein, we present 2 cases. A 77-year-old female patient presented with right renal tumor 89 mm in diameter with thrombus level IV considerably unresectable started to receive treatment with nivolumab and cabozantinib. After 6 months of treatment thrombus was reduced to level II. A 43-year-old male, presented with 110 mm- right renal mass with thrombus level II and lung metastases. He started to receive pembrolizumab and axitinib. At 6 months of treatment, the size of the tumor and thrombus decreased. In both cases we performed laparoscopic radical nephrectomy with thrombectomy, and pathology reports indicated the presence of clear cell RCC, Grade 3, pT3b-Nx.
Systemic treatment in patients with RCC associated with tumor thrombus, whether metastatic or not, would seem to obtain some benefit prior to surgery -line favor surgical feasibility.
