Surveillance for metastatic disease after definitive treatment for renal cell carcinoma
- Brian Shuch, MD
Brian Shuch, MD
- Assistant Professor
- Department of Urology
- Yale School of Medicine
- Allan J Pantuck, MD, MS, FACS
Allan J Pantuck, MD, MS, FACS
- Associate Professor
- UCLA David Geffen School of Medicine
- Tobias Klatte, MD
Tobias Klatte, MD
- UCLA David Geffen School of Medicine
For patients with renal cell carcinoma (RCC), surgery may be curative when patients present with localized disease. However, many patients who are initially resected eventually relapse, and the prognosis in these cases is often poor. Thus, optimal management requires careful surveillance for recurrent disease in those who have undergone a potentially curative resection.
The timing and patterns of recurrent and/or metastatic disease and specific recommendations for surveillance following the initial treatment of localized RCC will be reviewed here. An overview of the treatment of RCC is presented separately. (See "Prognostic factors in patients with renal cell carcinoma".)
The advantages of an aggressive surveillance program must be balanced against the financial costs and the psychologic distress that repeated testing can cause the patient. The rationale for surveillance is based upon several observations:
●Diagnosis of recurrence while the metastatic burden is limited may increase the likelihood of a favorable response to systemic treatment. (See "Immunotherapy of renal cell carcinoma", section on 'Interleukin-2'.)
●Surgical resection of a single or limited number of metastases or an isolated local-regional recurrence can result in long-term survival. (See "Role of surgery in patients with metastatic renal cell carcinoma" and 'Locoregional recurrence' below.)
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- TIME TO RECURRENCE
- Duration of surveillance
- Late recurrences
- SITES OF METASTASIS
- Lung metastases
- Bone metastases
- Liver metastases
- Locoregional recurrence
- Brain metastases
- Impact of histology
- SURVEILLANCE PROTOCOLS
- AUA guidelines
- - Stage I or T1N0/X (partial or radical nephrectomy)
- - PT2-4N0/X or pTanyN1
- NCCN guidelines
- - Stage I
- - Stage II/III
- Biomarkers and the future of surveillance
- SURVEILLANCE AFTER THERMOABLATION
- ADJUVANT THERAPY
- SUMMARY AND RECOMMENDATIONS