When considering cytoreductive nephrectomy in metastatic kidney cancer, in which situations would you consider nephron-sparing approaches such as partial nephrectomy or SBRT?

Nephron-sparing strategies (partial nephrectomy or stereotactic radiation therapy are reserved for patients with limited disease, favorable anatomy, or contraindications to surgery, where the goal is to maximize oncologic control while preserving renal function and minimizing morbidity. Careful multidisciplinary evaluation is essential to identify appropriate candidates.

Partial nephrectomy is appropriate for patients with unilateral, surgically resectable tumors (especially T1–T2) where nephron preservation is possible and oncologic control is not compromised, or when nephron preservation is imperative such as solitary kidney, bilateral tumors, or pre-existing renal insufficiency, or young age or comorbidities that increase the risk of prog...