(UroToday.com) The International Kidney Cancer Symposium 2021 annual hybrid meeting included a role of perioperative therapy in renal cell carcinoma (RCC) session and a presentation by Dr. Raquibul Hannan discussing the role of neoadjuvant stereotactic body radiotherapy in patients with RCC and IVC tumor thrombus. Among patients with newly diagnosed RCC, 4-10% of cases invade the IVC, with invasion ranging from the renal vein all the way to the right atrium (Level I IV). Inherently, these tumors can be associated with a grave prognosis and fatal complications, including venous congestion, Budd-Chiari syndrome, pulmonary embolism and metastasis. The only potentially curative treatment for patients with an IVC thrombus is surgical resection, which is associated with a 35% rate of high-grade peri-operative morbidity and 5-13 rate of peri- and post-operative mortality. However, there is an increased risk of relapse and metastasis even after curative resection.