Would you recommend starting treatment for a renal cell carcinoma patient with new low-burden, asymptomatic sub-centimeter bilateral pulmonary nodules that arise after a short disease-free interval (<6 months) after nephrectomy for stage I disease?  

This patient generally fits the phenotype of someone I would consider for initial observation. Usually if you look closely at prior scans, such nodules were present but unappreciated. There are prospective data supporting such an approach. Having said that, it also depends on the age and performance...

I share the good @Brian I. Rini's perspective regarding this patient's favorable disease biology.  The therapy burden for TKI's are significant.  Perhaps as we evolve towards the potential to offer curative therapy we will revisit this type of patient, but for now expectant management seem...

I think cases such as this require careful review of prior scans. Often nodules described as 'new' in a radiology report often have been there prior and unappreciated. A short interval of observation (e.g. 3 months) often will declare if the patient truly has indolent disease or not.