Is it time to include CT brain scans in high-risk renal cell carcinoma follow-up?
BAUS ePoster online library. Smith P. 06/23/21; 319033; p12-5
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Peter Smith
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Abstract
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Introduction
Follow-up imaging post nephrectomy in renal cell carcinoma (RCC) is determined by risk-group. Despite the estimated incidence of brain metastases for RCC being 6%, neither European Association of Urology (EAU) nor American Urological Association (AUA) advocate routine computed tomography brain scan (CTBS) as part of follow up surveillance. We investigated the incidence of brain metastases specific to high-risk RCC.
Materials and Methods
All nephrectomies performed in a single centre high-volume unit were retrospectively analysed over a five-year period (2013-18) and those deemed high-risk using SSIGN criteria identified. Each high-risk patient had their follow-up imaging reviewed to estimate the incidence of brain metastases.
Results
82 patients were identified as high-risk RCC with median follow-up of 3 years, (range 6-72 months). 33 of the 82 patients (40%) had CTBS throughout their follow-up with 14 (16.5%) demonstrating brain metastases.
11 of 14 patients with brain metastases were symptomatic. Of those identified with brain metastases, 2 had isolated disease, 6 had other single site recurrences and 6 had multiple truncal recurrences. 12 of the 14 brain metastases were identified within 3 years of nephrectomy with 10 within the first 24 months.
Conclusions
The incidence of brain metastases in high-risk RCC in our cohort is 16.5% and 42% of patients undergoing CTBS. There is a proportion with solitary brain or single other site metastases which may benefit from further specific treatment or change their oncological treatment plans if metastases identified. We hypothesise that guidance specific to high-risk RCC follow-up should include routine yearly CTBS.
Follow-up imaging post nephrectomy in renal cell carcinoma (RCC) is determined by risk-group. Despite the estimated incidence of brain metastases for RCC being 6%, neither European Association of Urology (EAU) nor American Urological Association (AUA) advocate routine computed tomography brain scan (CTBS) as part of follow up surveillance. We investigated the incidence of brain metastases specific to high-risk RCC.
Materials and Methods
All nephrectomies performed in a single centre high-volume unit were retrospectively analysed over a five-year period (2013-18) and those deemed high-risk using SSIGN criteria identified. Each high-risk patient had their follow-up imaging reviewed to estimate the incidence of brain metastases.
Results
82 patients were identified as high-risk RCC with median follow-up of 3 years, (range 6-72 months). 33 of the 82 patients (40%) had CTBS throughout their follow-up with 14 (16.5%) demonstrating brain metastases.
11 of 14 patients with brain metastases were symptomatic. Of those identified with brain metastases, 2 had isolated disease, 6 had other single site recurrences and 6 had multiple truncal recurrences. 12 of the 14 brain metastases were identified within 3 years of nephrectomy with 10 within the first 24 months.
Conclusions
The incidence of brain metastases in high-risk RCC in our cohort is 16.5% and 42% of patients undergoing CTBS. There is a proportion with solitary brain or single other site metastases which may benefit from further specific treatment or change their oncological treatment plans if metastases identified. We hypothesise that guidance specific to high-risk RCC follow-up should include routine yearly CTBS.
Introduction
Follow-up imaging post nephrectomy in renal cell carcinoma (RCC) is determined by risk-group. Despite the estimated incidence of brain metastases for RCC being 6%, neither European Association of Urology (EAU) nor American Urological Association (AUA) advocate routine computed tomography brain scan (CTBS) as part of follow up surveillance. We investigated the incidence of brain metastases specific to high-risk RCC.
Materials and Methods
All nephrectomies performed in a single centre high-volume unit were retrospectively analysed over a five-year period (2013-18) and those deemed high-risk using SSIGN criteria identified. Each high-risk patient had their follow-up imaging reviewed to estimate the incidence of brain metastases.
Results
82 patients were identified as high-risk RCC with median follow-up of 3 years, (range 6-72 months). 33 of the 82 patients (40%) had CTBS throughout their follow-up with 14 (16.5%) demonstrating brain metastases.
11 of 14 patients with brain metastases were symptomatic. Of those identified with brain metastases, 2 had isolated disease, 6 had other single site recurrences and 6 had multiple truncal recurrences. 12 of the 14 brain metastases were identified within 3 years of nephrectomy with 10 within the first 24 months.
Conclusions
The incidence of brain metastases in high-risk RCC in our cohort is 16.5% and 42% of patients undergoing CTBS. There is a proportion with solitary brain or single other site metastases which may benefit from further specific treatment or change their oncological treatment plans if metastases identified. We hypothesise that guidance specific to high-risk RCC follow-up should include routine yearly CTBS.
Follow-up imaging post nephrectomy in renal cell carcinoma (RCC) is determined by risk-group. Despite the estimated incidence of brain metastases for RCC being 6%, neither European Association of Urology (EAU) nor American Urological Association (AUA) advocate routine computed tomography brain scan (CTBS) as part of follow up surveillance. We investigated the incidence of brain metastases specific to high-risk RCC.
Materials and Methods
All nephrectomies performed in a single centre high-volume unit were retrospectively analysed over a five-year period (2013-18) and those deemed high-risk using SSIGN criteria identified. Each high-risk patient had their follow-up imaging reviewed to estimate the incidence of brain metastases.
Results
82 patients were identified as high-risk RCC with median follow-up of 3 years, (range 6-72 months). 33 of the 82 patients (40%) had CTBS throughout their follow-up with 14 (16.5%) demonstrating brain metastases.
11 of 14 patients with brain metastases were symptomatic. Of those identified with brain metastases, 2 had isolated disease, 6 had other single site recurrences and 6 had multiple truncal recurrences. 12 of the 14 brain metastases were identified within 3 years of nephrectomy with 10 within the first 24 months.
Conclusions
The incidence of brain metastases in high-risk RCC in our cohort is 16.5% and 42% of patients undergoing CTBS. There is a proportion with solitary brain or single other site metastases which may benefit from further specific treatment or change their oncological treatment plans if metastases identified. We hypothesise that guidance specific to high-risk RCC follow-up should include routine yearly CTBS.
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