How would you treat oligometastatic kidney cancer in a young, fit patient with recurrence <6 months after nephrectomy?

This is a good question. Short time to recurrence of mets would generally indicate more aggressive biology i.e., the mets aren't really oligo and other mets are lurking. Having said that, careful review of prior scans may reveal that the metastatic sites were present prior to being fully recognized on the current scan and thus could support a more indolent biology. I would lean towards a more aggressive local approach in a young, fit patient but of course, depends on site and number of metastases (i.e., CNS/bone mets that require local tx vs lung mets spread out over both lobes). An additional option is a short-interval scan to further define the true biology in a given patient. Time generally makes you smarter in knowing how to approach a given patient.