Table 4.

Subcategories of OM RCC based on risk of distant metastases.

1. Metachronous metastases (>1 year after resection of primary renal tumor)	Indolent disease; best prognosis	Active surveillance Metastasectomy SABR Systemic therapy [72,73,86,87]
2. IMDC favorable or intermediate risk	High risk of occult micrometastases	Systemic therapy eventually necessary Upfront sequential SABR can preserve health-related quality of life and postpone systemic therapy [88,89]
3. IMDC high risk, grade 4 or sarcomatoid component histology	High risk of occult micrometastatic disease with anticipated rapid progression	Upfront systemic therapy Consolidation with SABR to OM disease sites [59]