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Management of Localized and Locally Advanced Disease
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===== CUA ===== *'''2018 CUA''' ** '''See Table 1 from Original Guideline for Surveillance Schedule''' ** '''If patient is symptomatic or has an abnormal blood test, earlier radiological investigations may be indicated''' ** '''Low-risk (pT1)''' *** '''Abdominal imaging (CT/MRI/US) is recommended at 24 and 60 months''' **** US is less sensitive than CT, however, its use is justifiable and cost-effective in patients with a minimal risk of abdominal recurrence and lower BMI *** '''Follow-up is the same for PN for lesions <4 cm,''' since local recurrence rates in this population are similar to RN **** '''Postoperative CT abdomen at 3β12 months is optional for patients treated with PN to evaluate the residual baseline renal appearance''' *** '''Routine imaging beyond 5 years is optional and can be risk-adapted''' ** '''Intermediate-risk (pT2)''' *** '''Abdominal imaging (CT/MRI/US) recommended at 12, 24, 36, and 60 months''' *** '''Routine imaging beyond 5 years is at the discretion of the treating physician''' ** '''High-risk (pT3-4)''' *** '''Abdominal CT or MRI is recommended every 6 months for 2 years, then at 36 and 60 months, then every 2 years''' ** '''Very high-risk (N+)''' *** '''Abdominal CT or MRI is recommended at 3 and 6 months, then every 6 months for 3 years, then yearly''' ** '''Imaging''' *** '''Abdomen''' **** '''CT abdomen/pelvis recommended,''' particularly in cases of tumour-associated symptoms ***** '''Abdominal US may be performed for lower-risk patients (pT1 and pT2)''' *** '''Chest''' **** '''Modality''' ***** '''CXR recommended''' ***** '''CT chest in higher-risk patients''' due to the higher sensitivity of this test compared to CXR ****** Can consider alternating CT chest with CXR
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