Metastatic hypernephroma has been notoriously resistant to control by conventional methods of therapy. A review of 72 patients treated by various methods revealed that patients in whom metastases recurred 18 months or longer after initial diagnosis had a median survival of almost 15 months; those patients in whom metastases recurred less than 18 months after diagnosis had a median survival of about 8 months. Treatment with radiation therapy frequently palliated symptoms produced by local metastases, but did not alter survival patterns. Excision of single metastatic deposits was associated with increased survival in three of four patients with pulmonary metastases and in two of three patients with thyroid metastases. Systemic chemotherapy was generally unrewarding. However, two excellent objective regressions were observed in 16 patients treated with progestational agents.