RADIOLOGIC FOLLOW-UP OF PATIENTS WITH T1-3A,B,C OR T4N-CELL CARCINOMAAFTER RADICAL NEPHRECTOMY(MO RENAL)

Objectives. To determine the pattern of disease recurrence after radic al nephrectomy in patients with node-positive renal cell carcinoma (RC C) in order to design a schedule for subsequent radiologic evaluation. Methods. We reviewed the postoperative radiologic studies of 45 patie nts with T1-3a,b,c or T4N + M0 RCC enrolled in a prospective trial of adjuvant autolymphocyte therapy (ALT) after radical nephrectomy for no de-positive disease. Chest radiograph and abdominal computed tomograph y (CT) were performed quarterly, and bone scan and head CT were perfor med every 6 months until disease recurrence, or earlier if clinically indicated. Time from surgery to recurrence and sites of recurrence wer e analyzed. Results. Twenty-nine patients (64%) had disease progressio n, with a mean time to progression of 14.9 months. Mean follow-up of p atients without progression was 39 months. The sites of recurrence wer e retroperitoneal lymph nodes (n = 14), lung (n = 11), liver (n = 5), bone (n = 5), mediastinal lymph nodes (n = 4), renal fossa (n = 3), pe lvis (n = 2), brain (n = 2), contralateral kidney (n = 1), retrocecum (n = 1), and skin (n = 1). Fourteen patients had recurrence at more th an one site. Of the patients whose disease progressed, 59% did so by 1 2 months, 83% by 24 months, and 93% by 36 months. Mean time to progres sion in the ALT group was delayed compared with the observation group, but the sites of disease recurrence were not different between the tw o groups. Abdominal CT alone detected recurrent lesions in 79% of pati ents with progression, and the combination of abdominal CT and chest r adiograph detected lesions in 100% of patients with progression. Concl usions. Abdominal CT with chest radiograph detects recurrence in all p atients with T1-3a,b,c or T4N+M0 RCC whose disease progresses, and mor e than 90% of recurrences occur within the first 5 years after surgery . We recommend abdominal CT and chest radiograph every 6 months for at least 5 years and yearly thereafter in this high-risk group of patien ts. (C) 1998, Elsevier Science Inc. All rights reserved.