Follow-up after focal therapy in renal masses: an international multidisciplinary Delphi consensus project.
OBJECTIVE
To establish consensus on follow-up (FU) after focal therapy (FT) in renal masses. To formulate recommendations to aid in clinical practice and research.


METHODS
Key topics and questions for consensus were identified from a systematic literature research. A Web-based questionnaire was distributed among participants selected based on their contribution to the literature and/or known expertise. Three rounds according to the Delphi method were performed online. Final discussion was conducted during the "8th International Symposium on Focal Therapy and Imaging in Prostate and Kidney Cancer" among an international multidisciplinary expert panel.


RESULTS
Sixty-two participants completed all three rounds of the online questionnaire. The panel recommended a minimum follow-up of 5 years, preferably extended to 10 years. The first FU was recommended at 3 months, with at least two imaging studies in the first year. Imaging was recommended biannually during the second year and annually thereafter. The panel recommended FU by means of CT scan with slice thickness ≤3 mm (at least three phases with excretory phase if suspicion of collecting system involvement) or mpMRI. Annual checkup for pulmonary metastasis by CT thorax was advised. Outside study protocols, biopsy during follow-up should only be performed in case of suspicion of residual/persistent disease or radiological recurrence.


CONCLUSIONS
The consensus led to clear FU recommendations after FT of renal masses supported by a multidisciplinary expert panel. In spite of the low level of evidence, these recommendations can guide clinicians and create uniformity in the follow-up practice and for clinical research purposes.
Department of Urology, AMC University Hospital, PO box 22660, 1100DD, Amsterdam, The Netherlands. p.j.zondervan@amc.uva.nl.
P J
PJ
Zondervan
Department of Urology, AMC University Hospital, PO box 22660, 1100DD, Amsterdam, The Netherlands.
P G K
PG
Wagstaff
Department of Urology, Keck School of Medicine USC, Los Angeles, CA, USA.
M M
MM
Desai
Department of Urology, AMC University Hospital, PO box 22660, 1100DD, Amsterdam, The Netherlands.|Department of Biomedical Engineering and Physics, AMC University Hospital, Amsterdam, The Netherlands.
D M
DM
de Bruin
Department of Urology, Centro Hospitalar do Porto, Porto, Portugal.
A F
AF
Fraga
Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
B A
BA
Hadaschik
Department of Pathology, Sana Klinikum Offenbach, Offenbach, Germany.
J
J
Köllermann
Department of Urology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
U B
UB
Liehr
Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.
S A
SA
Pahernik
Department of Urology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
H P
HP
Schlemmer
Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
J J
JJ
Wendler
Department of Pathology, Fundació Puigvert, Barcelona, Spain.
F
F
Algaba
Department of Urology, AMC University Hospital, PO box 22660, 1100DD, Amsterdam, The Netherlands.
J J M C H
JJ
de la Rosette
Department of Urology, AMC University Hospital, PO box 22660, 1100DD, Amsterdam, The Netherlands.
M P
MP
Laguna Pes
D003131:Combined Modality Therapy; D032921:Consensus; D003697:Delphi Technique; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000628:therapy*; D011795:Surveys and Questionnaires
Consensus; Delphi method; Focal therapy; Follow-up; Renal masses