1303 SIGNIFICANT VARIABILITY IN 10-YEAR CUMULATIVE RADIATION EXPOSURE INCURRED ON DIFFERENT SURVEILLANCE REGIMENS FOLLOWING SURGERY FOR PT1 RENAL CANCERS – YET ANOTHER REASON TO STANDARDIZE PROTOCOLS?

for this article http://dx.doi.org/10.1016/j.juro.2013.07.072 available at http://jurology.com/ Editorial Comment: The last decades witnessed increasing concern regarding radiation exposure risks, either after therapeutic interventions or in surveillance protocols after oncologic surgery. In patients with renal cell carcinoma (RCC) the knowledge and recommendations on surveillance protocols (test and frequency) are mostly based on retrospective series and risk adapted systems. The lack of uniformity resulted in a wide variation in radiation exposure for the 2 index cases defined in this study (pT1a clear cell RCC, Fuhrman grade 2 and pT1b clear cell RCC, Fuhrman grade 3) in several analyzed surveillance regimens. With the trend to diagnose RCC in early stages and in younger individuals, a lower rate of metastatic events is expected, although longer followup might be indicated. Although the index patients defined in this study are considered at low risk for recurrence based on the recent American Urological Association RCC followup guidelines, intuition suggests that the biological potential of both tumors might be different. Individual demographic and medical conditions will dictate the need for early diagnosis of recurrence or an abstention policy. Lastly, while a large body of literature is available on the high/rapid exposure risk of cancer development, little is known about the cumulative effects of low regular exposure. The challenge in coming years will be to find balance between radiation risk and timely/effective diagnosis of recurrence. Identification of patterns of recurrence according to distinct tumor stages and individualized risk, including supplementary pathological features (eg nomograms), should be explored and tested to determine the subpopulation in which a more intensive followup regimen will be beneficial despite increased exposure risk. M. Pilar Laguna, M.D., Ph.D.