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Renal cell carcinoma (RCC) often presents with tumor thrombus (TT) in the inferior vena cava (IVC), posing significant therapeutic challenges, particularly in cases of metastatic or inoperable disease. While surgical excision remains the standard treatment approach, recent advancements in radiotherapy techniques may offer alternative strategies. We present the clinical picture of a 74-year-old male with metastatic RCC, who presented with recurrent IVC-TT, detected by surveillance computed tomography imaging, and complained of mild lower leg edema. This was successfully managed with stereotactic body radiotherapy (SBRT), resulting in a slow but continuous shrinkage of the IVC-TT with almost complete regression of most lung, liver, and lymph node metastases, obtaining a full resolution of the mild bilateral leg edema. The case described here highlights the possibility of using radiotherapy as a safe and tolerable treatment for inoperable or metastatic patients with IVC-TT. Additionally, we conducted a literature review looking for evidence of the effectiveness of radiotherapy in RCC patients with IVC-TT across different treatment settings. This case-based review ultimately aims to shed light on the emerging evidence supporting the usefulness of radiotherapy in such complex clinical challenges, hopefully paving the way for well-organized trials. [ABSTRACT FROM AUTHOR]

Historically, radiation therapy has been devoted to the achievement of local control both in early and advanced disease, palliation of symptoms (i.e. pain), and the treatment of cancer complications (i.e. bone fractures, bleeding) in advanced/metastatic cancer. Recently, the discovery of the role of radiation therapy as a trigger to activate the immune system has led to an increased interest among insiders regarding the interaction between radiation therapy and host immune reactions. The immune systemic effects of radiation therapy are widely acknowledged to be both immunosuppressive and immunostimulant, albeit there exists considerable uncertainty regarding the doses/fraction that can induce them. The main aim of this brief paper is to describe the systemic anti-tumor responses following radiation therapy on the basis of selected doses/fraction. [ABSTRACT FROM AUTHOR]