Systemic Therapy Alone or With Stereotactic Body Radiotherapy for Oligometastatic Kidney Cancer (STROKER Study)

Inclusion Criteria:

• Pathologically confirmed diagnosis of renal cell carcinoma of any histology

• Age ≥ 18 years.

• ECOG performance status of 0-2.

• Imaging suggests the presence of distant metastases, with no more than 5 metastaticlesions according to RECIST 1.1 criteria and MDA standards.

• The patient has received local therapy to primary site, including surgery,stereotactic radiotherapy, or ablation.

• The patient has received no more than 2 lines of systemic therapy.

• No significant impairment of major organ function:

Hemoglobin (HB) ≥ 80 g/L Absolute neutrophil count (ANC) ≥ 1.5 × 10⁹/L Platelets (PLT) ≥ 75 × 10⁹/L Serum total bilirubin ≤ 1.5 × ULN Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3 × ULN Prothrombin time (PT) and activated partial thromboplastin time (aPTT) ≤ 1.5 × ULN

Exclusion Criteria:

• Presence of intracranial metastases.

• Target lesions have previously received high-dose irradiation with .

• Target lesions are unsuitable for radiation therapy judged by treating radiationoncologist (e.g., lesions invading the gastrointestinal tract or penetrating thebronchus).

• Uncontrollable metastatic pleural effusion or ascites.

• Presence of other malignancies that have not been cured.

• History of significant psychiatric disorders that impede understanding of informedconsent and compliance with the study protocol.

• Presence of other serious illnesses that may pose significant risks or affectradiation therapy.

• Women who are pregnant, breastfeeding, or with plans for childbearing during thestudy.

• Any other reasons deemed by the investigator to make the subject unsuitable forparticipation in the study.