How would you manage this patient?
Surgical resection of the local recurrence should be strongly considered given that this is the only established site of disease — it is analogous to a solitary metastasis. It is important to emphasize that RCC is still a surgical disease with respect to curative potential. Based on the imaging surgical resection appears to be possible, although it may require partial hepatectomy or resection/reconstruction of the IVC. However, if the final judgment is that surgical excision is not possible or if the potential morbidity is thought to be prohibitive, an alternate approach can be considered whereby systemic therapy is administered first followed by surgical consolidation. Ideally the agent chosen would yield substantial downsizing to facilitate surgical resection. Targeted agents with relatively high response rates have included sunitinib, pazopanib, and bevacizumab/IFN, and all could be considered in this circumstance.
The patient was treated with sunitinib locally with reassessment after three months and seven months. The original tumor size was 6.9cm. After three months the tumor was 6.4cm. At seven months it was 6.9cm again.
What is the next step?