Surveillance Strategies After Surgery for Renal Cell Carcinoma
One in five patients who undergo surgical resection for localized renal cell carcinoma develops local and/or distant recurrences. When these recurrences are detected early, they might be amenable to salvage therapies, but the ideal surveillance strategy for these patients is still disputed, according to Mark D. Tyson, MD, and Sam S. Chang, MD, MBA, of Vanderbilt University Medical Center, Nashville. They published a review of optimal surveillance protocols after surgery for renal cell carcinoma in the June 2017 issue of the Journal of the National Comprehensive Cancer Network.
Since about half of recurrences appear within the first 2 years after surgery, a clear rationale exists for optimizing surveillance strategies during this period, but there may also be a rationale for long-term surveillance among high-risk patients. Due to the capricious nature of the timing and location of recurrences, as well as the lack of evidence supporting the benefit of early salvage therapy, physicians tend to disagree on what constitutes an “optimal” strategy.
In their review, the investigators provide an outline of justifications both supporting and disputing the merits of surveillance after surgery, a summary of the American Urological Association (AUA) and National Comprehensive Cancer Network® (NCCN®) Guidelines (which attempt to balance the burden of surveillance with its potential clinical benefit), costs, and ancillary issues.