Follow-up for clinically localized RCC

Kidney cancer. Principles and practice. Second edition. Primo N. Lara, Jr. Eric Jonasch (Editors). Springer International Publishing (2015)

In 2013, the American Urological Association released guidelines for the follow-up and surveillance of clinically localized RCC managed by AS, partial nephrectomy, radical nephrectomy, or ablative techniques. Abdominal CT, US, or MRI should be preformed within 6 months of active surveillance initiation to establish growth rate and continued imaging at least annually thereafter [93]. Other imaging studies should be ordered as clinically indicated.

For renal masses treated with an ablative technique, abdominal cross-sectional imaging, with and without IV contrast, unless contraindicated, should be performed at 3 and 6 months postoperatively with continued imaging annually for 5 years. Imaging beyond 5 years is optional based upon individual patient risk factors. Biopsy should be performed pretreatment and again for the following indications: if there is new enhancement, an interval progression in size of an ablated tumor or tumor bed with or without enhancement, new nodularity in or around treatment zone, failure of treated lesion to regress over time, or satellite or port side lesions [93].

After partial nephrectomy for low-risk disease (pT1, N0, Nx), a baseline abdominal CT or MRI should be performed 3–12 months following surgery. If the initial postoperative scan is negative, abdominal imaging may be performed annually for 3 years based upon patient risk factors. After radical nephrectomy for low-risk disease, again baseline imaging should be preformed 3–12 months following surgery. If the initial postoperative imaging is negative, imaging after 12 months is at the physician’s discretion. After both radical and partial nephrectomy for low-risk disease, the patient should undergo an annual chest x-ray for 3 years and then again as clinically indicated [93].

For moderateto high-risk disease (pT2-4N0 Nx or any stage N+), baseline abdominal imaging should be performed 3–6 months following surgery with continued imaging every 6 months for at least 3 years and annually through year 5.

Beyond 5 years, imaging is at physician’s discretion. Baseline CT chest is within 3–6 months following surgery with continued CXR or CT every 6 months for 3 years then annually through year 5. Again, chest imaging beyond 5 years is at the discretion of the physician and based upon individual patient risk factors [93].

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