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10 - Post-treatment surveillance of renal cancer

Published online by Cambridge University Press:  08 August 2009

By
Parvati Ramchandani
Edited by
Uday Patel
Parvati Ramchandani
Affiliation:
Department of Radiology, University of Pennsylvania, Medical Centre, Philadelphia, USA
Uday Patel
Affiliation:
St George's Hospital, London
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Summary

Introduction

If salvage surgery or immunotherapy is to be offered in a timely fashion for recurrent renal cancer, surveillance after treatment is important to ensure early detection of recurrence, although improved survival with such an approach has yet to be proven. Suggested surveillance protocols have been published to follow patients with treated renal cell carcinoma (RCC). However, in practice, there is little consensus on appropriate surveillance protocols amongst practicing urologists and a recent study documented that published guidelines are often not used with any consistency. This chapter is a review of the clinical features of recurrent disease and how they influence chosen surveillance methods and protocols.

Likelihood of recurrent renal cancer

Approximately a third of the patients who present with localized RCC will develop a local or distant recurrence after therapy. Higher T-stage tumors are associated with increased risk of tumor recurrence. Lam et al. recently reported that overall distant recurrence rate at 5 years after surgical resection was 27.6% for localized disease and 64% for node positive disease. Five-year recurrence-free rate after nephrectomy in patients stratified into a low risk group was 90.4%, intermediate risk group was 61.8%, and high risk group was 41.9%. Median time to recurrence was 28.9 months, 17.8 months, and 9.5 months in the low risk, intermediate risk, and high risk groups respectively.

Type
Chapter
Information
Carcinoma of the Kidney , pp. 185 - 202
Publisher: Cambridge University Press
Print publication year: 2007

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