肾癌2022v2（英文）-NCCN肿瘤临床实践指南

NCCNClinicalPracticeGuidelinesinOncologyNCCNGuidelines®)KidneyCancerrsionSeptemberNCCNGuidelinesforPatients®availableat/patientsVersion2.2022,9/8/2021©2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon10/4/202110:46:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.*RobertJ.Motzer,MD/Chair†Þ*EricJonasch,MD/Vice-chair†TheUniversityofTexasNeerajAgarwal,MD‡†AjjaiAlva,MBBS†UniversityofMichiganRogelCancerCenterMichaelBaine,MD§Fred&PamelaBuffetCancerCenterKathrynBeckermann,MD,PhD†Vanderbilt-IngramCancerCenterMariaI.Carlo,MD†ToniK.Choueiri,MD†ÞDana-Farber/BrighamandWomen’sCancerCenterBrianA.Costello,MD,MS†IthaarH.Derweesh,MDωcerCenterArpitaDesai,MD†ÞUCSFHelenDillerFamilyCenterYasserGed,MBBS†hensiveCancersSabyGeorge,MD†lParkComprehensiveCancerCenteresPanelDisclosuresJohnL.Gore,MD,MSωCancerCareAllianceNaomiHaas,MD†nterStevenL.Hancock,MD§ÞPayalKapur,MD≠CancerCenterChristosKyriakopoulos,MD‡UniversityofWisconsinCarboneCancerCenterElaineT.Lam,MD†UniversityofColoradoCancerCenterPrimoN.Lara,MD†UCDavisComprehensiveCancerCenterClaytonLau,MDωCityofHopeNationalMedicalCenterDavidC.Madoff,MD∩YaleCancerCenter/SmilowCancerHospitalBrandonManley,MDωMoffittCancerCenterM.DrorMichaelson,MD,PhD†cerCenterAmirMortazavi,MD†eCancerCenterJamesCancerHospitalLakshminarayananNandagopal,MD†O'NealComprehensiveCancerCenteratUABElizabethR.Plimack,MD,MS†ÞFoxChaseCancerCenterLeePonsky,MDωhensiveCancerCenterSundharRamalingam,MD†BrianShuch,MDωCLAJonssonComprehensiveCancerCenterZacharyL.Smith,MDωSitemanCancerCenteratBarnes-JewishHospitalandWashingtonUniversitySchoolofMedicineJeffreySosman,MD‡erBSNRNlaMotterPhD†Medicaloncology¥Patientadvocacy§Radiotherapy/Radiationoncology*DiscussionwritingcommitteememberanelMembersyoftheGuidelinesUpdateslowUpforStageIIIIKIDanelMembersyoftheGuidelinesUpdateslowUpforStageIIIIKIDKIDeatmentKIDgeryKIDABSystemicTherapyforRelapseorStageIVDiseaseKIDCCarcinomaCriteriaforFurtherGeneticRiskEvaluationforHereditaryRCCSyndromes(HRCC-1)HereditaryRCCSyndromesOverview(HRCC-2)GeneticTesting(GENE-1)Kidney-SpecificScreeningRecommendationsforPatientswithConfirmedHereditaryRCC(HRCC-B)Kidney-SpecificSurgicalRecommendationsforPatientswithConfirmedHereditaryRCC(HRCC-C)Kidney-SpecificSystemicTherapyforPatientswithConfirmedHereditaryRCC(HRCC-D)dexlievesthatthebestmanagementforanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.FindanNCCNMemberInstitution:/home/member-institutions.ofEvidenceandsusAllrecommendationsotherwisedNCategoriesofEvidenceandConsensus.NCCNCategoriesofPreference:Allrecommendationsareconsideredappropriate.SeeNCCNCategoriesofPreference.TheNCCNGuidelinesareastatementofevidenceandconsensusoftheauthorsregardingtheirviewsofcurrentlyacceptedapproachestotreatment.AnyclinicianseekingtoapplyorconsulttheNCCNGuidelinesisexpectedtouseindependentmedicaljudgmentinthecontextofindividualclinicaltancestodetermineanypatientscareortreatmentTheNationalComprehensiveCancerNetworkNCCNmakesnorepresentationsorwarrantiesofanykindregardingtheircontentuseorapplicationanddisclaimsanyresponsibilityfortheirapplicationoruseinanyway.TheNCCNbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.©2021.Version2.2022,9/8/2021©2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.rinciplesofSystemicTherapypFirst-LineTherapyforClearCellHistology:◊FavorableRisk,PreferredRegimens–Axitinib+pembrolizumab(changedfromcategory2Atocategory1)–PazopanibrinciplesofSystemicTherapypFirst-LineTherapyforClearCellHistology:◊FavorableRisk,PreferredRegimens–Axitinib+pembrolizumab(changedfromcategory2Atocategory1)–PazopanibmovedtoOtherRecommendedRegimens;–SunitinibmovedtoOtherRecommendedRegimens;–UsefulinCertainCircumstancesdexsionoftheNCCNGuidelinesforKidneyCancerfromVersioninclude•KidneySpecificSystemicTherapyforPatientswithConfirmedHereditaryRCCpForHLRCC,erlotinibplusbevacizumabwillbeacategory2A,UsefulinCertainCircumstancesrecommendation.pForTSC,everolimuswillbeacategory2A,UsefulinCertainCircumstancesrecommendation.pForVHL,belzutifanwasaddedasacategory2A,PreferredRegimenrecommendation;pazopanibwillbeacategory2A,UsefulinCertainCircumstancesrecommendation.onoftheNCCNGuidelinesforKidneyCancerfromVersionincludent◊UsefulntpStage1revised:Radicalnephrectomy(inselectpatients)pStage1revised:Radicalnephrectomy(inselectpatients)ifnephron-sparingnotindicatedorfeasible)•Footnotearevised:Imagingwithandwithoutcontrast....•Footnoteenew:Stereotacticbodyradiotherapy(SBRT)maybeconsideredformedicallyinoperablepatientswithStageIkidneycancer(category2B)orwithStageII/IIIkidneycancer(bothcategory3)•Footnotecrevised:RiniBI,DorffTB,ElsonP,etal.Activesurveillanceinmetastaticrenal-cellcarcinoma:aprospective,phase2trial.LancetOncol2016;17:1317-1324.HarrisonMR,etal.Activesurveillanceofmetastaticrenalcellcarcinoma:Resultsfromaprospectiveobservationalstudy(MaRCC).Cancer.2021Mar25.BexwithStageII/IIIkidneycancer(bothcategory3)inciplesofSurgerymetastaticrenalcancerinciplesofSurgeryKID-C,2of2ofpSystemicTherapyforof◊Preferredregimens:CabozantinibmovedfromOtherRecommendedRegimens◊OtherRecommendedRegimens:–EverolimusmovedtoUsefulinCertainCircumstances–NivolumabmovedfromUsefulinCertainCircumstances–Pembrolizumabadded◊UsefulinCertainCircucmstances:High-doseIL-2(changedfromcategory2Atocategory2B)–RevisedHigh-doseIL-2(changedfromcategory2Atocategory2B)inCertainCircumstances–High-doseIL-2–High-doseIL-2(changedfromcategory2Atocategory3)–Temsirolimus(changedfromcategory2Atocategory3)•HereditaryRCCSyndromesOverviewpSubsequentTherapyforClearCellHistology◊PreferredpSubsequentTherapyforClearCellHistology◊PreferredRegimens–Ipilimumab+nivolumabmovedtoOtherRecommendedRegimens–Lenvatinib+everolimus(category1)movedfromOtherRecommendedRegimens◊OtherRecommendedRegimens–EverolimusmovedtoUsefulinCertainCircumstances–Cabozantinib+nivolumabaddedpBirt-Hogg-Dubésyndrome(BHDS)/FLCNgene:UnderCommonHistologies,revisedoncocytomaictumors,papillaryRCCpHereditaryparaganglioma/pheochromocytoma(PGL/PCC)syndrome/SDHA/B/C/Dgenes:UnderInheritancePattern,removedbenignlunglesions•HRCC-ApTable2–Lenvatinib+pembrolizumabadded◊AdrenalorparapangliomaPheochromocytomasUPDATESVersion2.2022,9/8/2021©2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.•Abdominal±pelvicCTaorMRIaPrintedbyMinTangon10/4/202110:46:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.•Abdominal±pelvicCTaorMRIadexPRIMARYTREATMENTd,eADJUVANTTREATMENTINITIALWORKUPSPRIMARYTREATMENTd,eADJUVANTTREATMENTINITIALWORKUPSTAGEPartialnephrectomy(preferred)StageStageIususHP•CBCwithdifferential,comprehensivemetabolicpanel,LDH•Urinalysis•Chestx-ray•IfclinicallyindicatedpBonescan,pChestCTapConsidercoreneedlebiopsy•Ifurothelialcarcinomasuspected(eg,centralmass),considerurinecytology,ureteroscopyorpercutaneous•Ifmultiplerenalmasses,≤46y,orfamilyhistory,considergeneticevaluation.SeeHereditaryRenalCellCarcinomas(HRCC-1)orActivesurveillanceorSurveillancefSurveillancef(inselectpatients)PartialnephrectomyorStageIStageIFollow-upSeeKID-BDorActivesurveillance(inselectpatients)ClinicaltrialClinicaltrialveillanceflhistologycaltrialpreferredorRadicalnephrectomyveillancefveillancefindicatedorAdjuvantsunitinib(category3)DDaImagingwithandwithoutcontrastisstronglypreferred,suchasarenalprotocol.eStereotacticbodyradiotherapy(SBRT)maybeconsideredformedicallyinoperablepatientsguidesurveillanceorablativetechniques,cryosurgery,andradiofrequencyablationstrategies.fSeeFollow-up(KID-B).bBiopsyofsmalllesionsmaybeconsideredtoobtainorconfirmadiagnosisofmalignancyandwithStageIkidneyguidesurveillanceorablativetechniques,cryosurgery,andradiofrequencyablationstrategies.fSeeFollow-up(KID-B).cIfmetastaticdiseaseispresentorthepatientcannottolerateureteroscopy.gNosinglefollow-upplanisappropriateforallpatients.Follow-upshouldbeindividualizeddSeePrinciplesofSurgery(KID-A).basedonpatientrequirements.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version2.2022,9/8/2021©2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.KID-1PrintedbyMinTangon10/4/202110:46:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexSTAGEPRIMARYTREATMENTdresectableprimarygsamplingPotentiallysurgicallyresectableprimarygsamplingentsCytoreductivenephrectomySeeKID-entsSystemictherapy(SeeKID-3)(preferredinclearcellhistologywithpoor-riskfeatures)StageIVSurgicallyunresectablegTissuesamplingSeeKID-3dSeePrinciplesofSurgery(KID-A).gIndividualizetreatmentbasedonsymptomsandextentofmetastaticdisease.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.KID-2Version2.2022,9/8/2021©2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon10/4/202110:46:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexSIONClinicaltrialorSeeFirst-LineTherapy(KID-C,1of2)orstsupportivecarehMetastasectomyorSBRTorablativetechniquesforstsupportivecarehFollow-upSeeKID-BClinicaltrialorSeeSubsequentTherapyforClearCellHistology(KID-C,1of2)ststsupportivecarehNon-clearcellhistologyClinicaltrial(preferred)orSeeSystemicTherapy(KID-C,2of2)orstsupportivecarehMetastasectomyorSBRTorablativetechniquesforstsupportivecarehFollow-upSeeKID-BClinicaltrialorSeeSystemicTherapyforNon-ClearCellHistology(KID-C,2of2)ststsupportivecarehBestsupportivecarecanincludepalliativeRTbisphosphonatesorRANKligandinhibitorsforbonymetastasesNote:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.KID-3Version2.2022,9/8/2021©2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon10/4/202110:46:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexPRINCIPLESOFSURGERY•Nephron-sparingsurgery(partialnephrectomy)isappropriateinselectedpatients,forexample:pUnilateralstageI–IIItumorswheretechnicallyfeasiblepUninephricstate,renalinsufficiency,bilateralrenalmasses,andfamilialrenalcellcancerpPatientsatrelativeriskfordevelopingprogressivechronickidneydiseaseduetoyoungageormedicalriskfactors(ie,hypertension,diabetes,nephrolithiasis)Openlaparoscopicorroboticsurgicaltechniquesmaybeusedtoperformradicalandpartialnephrectomies.Regionallymphnodedissectionisoptionalbutisrecommendedforpatientswithresectableadenopathyonpreoperativeimagingorpalpable/visibleadenopathyattimeofsurgery.•Ifadrenalglandisuninvolved,adrenalectomymaybeomitted.Specialteamsorreferraltohigh-volumecentersmayberequiredforextensiveinferiorvenacavainvolvement.•Thermalablation(eg,cryosurgery,radiofrequencyablation)isanoptionforthemanagementofpatientswithclinicalstageT1renallesions.pThermalablationisanoptionformasses<3cm,butmayalsobeanoptionforlargermassesinselectpatients.Ablationinmasses>3cmisassociatedwithhigherratesoflocalrecurrence/persistenceandcomplications.pBiopsyofsmalllesionsconfirmsadiagnosisofmalignancyforsurveillance,cryosurgery,andradiofrequencyablationstrategies.pAblativetechniquesareassociatedwithahigherlocalrecurrenceratehievethesamelocaloncologicoutcomesabthanhievethesamelocaloncologicoutcomesab•ActivesurveillanceisanoptionfortheinitialmanagementofpatientswithclinicalstageT1renallesions,forexample:pPatientswithsmallrenalmasses<2cmgiventhehighratesofbenigntumorsandlowmetastaticpotentialofthesemasses.pActivesurveillanceofpatientswithT1atumors(≤4cm)thathaveapredominantlycysticcomponentisrecommended.pPatientswithclinicalstageT1massesandsignificantcompetingrisksofdeathormorbidityfromintervention.pActivesurveillanceentailsserialabdominalimagingwithtimelyinterventionshouldthemassdemonstratechanges(eg,increasingtumorsize,growthrate,infiltrativepattern)indicativeofincreasingmetastaticpotential.pActivesurveillanceshouldincludeperiodicmetastaticsurveyincludingbloodworkandchestimaging,particularlyifthemassdemonstratesgrowth.•Generally,patientswhowouldbecandidatesforcytoreductivenephrectomypriortosystemictherapyhave:pExcellentperformancestatus(ECOGPS<2)pNobrainmetastasisaCampbellS,UzzoR,AllafM,etal.Renalmassandlocalizedrenalcancer:AUAGuideline.JUrol2017;198:520-529.bPierorazioP,JohnsonM,PatelH,etal.Managementofrenalmassesandlocalizedrenalcancer:Systematicreviewandmeta-analysis.JUrol2016;196:989-999.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.KID-AVersion2.2022,9/8/2021©2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.KID-BOF5PrintedbyMinTangon10/4/202110:46:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2021NationalComprehensiveCancerNetwork,Inc.,AllRightsKID-BOF5dexFOLLOW-UPa,byBStageI(T1a)Follow-upDuringActiveSurveillancec•H&Pannually•Laboratorytestsannually,asclinicallyindicated•Abdominalimaging:pAbdominalCTorMRIwithcontrastifnocontraindicationwithin6moofsurveillanceinitiation,thenCT,MRI,orultrasound(US)atleastannually•Chestimaging:pChestx-rayorCTatbaselineandannuallyasclinicallyindicatedtoassessforpulmonarymetastases•Considerrenalmassbiopsyatinitiationofactivesurveillanceoratfollow-up,asclinicallyindicated•Follow-upmaybeindividualizedbasedonsurgicalstatus,treatmentschedules,sideeffects,comorbidities,andsymptomsFollow-upAfterAblativeTechniquesc•H&Pannually•Laboratorytestsannually,asclinicallyindicated•Abdominalimaging:pAbdominalCTorMRIwithandwithoutIVcontrastat1–6mofollowingablativetherapyunlessotherwisecontraindicated,thenCTorMRI(preferred),orUSannuallyfor5yorlongerasclinicallyindicated.IfpatientisunabletoreceiveIVcontrast,MRIisthepreferredimagingmodalitypIfthereisimagingorclinicalconcernsforrecurrence,thenmorefrequentimaging,renalmassbiopsy,orfurthertreatmentmaybeindicated•Chestimaging:pChestx-rayorCTannuallyfor5yforpatientswhohavebiopsy-provenlow-riskrenalcellcarcinoma(RCC),nondiagnosticbiopsies,ornopriorbiopsyaDonatSM,DiazM,BishoffJT,etal.Follow-upforclinicallylocalizedrenalneoplasms:AUAGuideline.JUrol2013;190:407-416.bNosinglefollow-upplanisappropriateforallpatients.Follow-upfrequencyanddurationshouldbeindividualizedbasedonpatientrequirements,andmaybeextendedbeyond5years(SeeKID-B,5of5).Furtherstudyisrequiredtodefineoptimalfollow-upduration.cImagingwithcontrastwhenclinicallyindicated.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version2.2022,9/8/2021©2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon10/4/202110:46:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexFOLLOW-UPa,byBStageI(pT1a)and(pT1b)cFollow-upAfteraPartialorRadicalNephrectomy•H&Pannually•Laboratorytestsannually,asclinicallyindicated•Abdominalimaging:pBaselineabdominalCTorMRI(preferred),orUSwithin3–12moofsurgery,thenannuallyfor3yorlongerasclinicallyindicatedpAmorerigorousimagingscheduleortechniquemodalitycanbeconsideredifpositivemarginsoradversepathologicfeatures(suchassarcomatoid,high-grade[grade3/4])•Chestimaging:pChestx-rayorCTannuallyforatleast5y,thenasclinicallyindicatedpAmorerigorousimagingscheduleortechniquemodalitycanbeconsideredifpositivemarginsoradversepathologicfeaturesaDonatSM,DiazM,BishoffJT,etal.Follow-upforclinicallylocalizedrenalneoplasms:AUAGuideline.JUrol2013;190:407-416.bNosinglefollow-upplanisappropriateforallpatients.Follow-upfrequencyanddurationshouldbeindividualizedbasedonpatientrequirements,andmaybeextendedbeyond5years(SeeKID-B,5of5).Furtherstudyisrequiredtodefineoptimalfollow-upduration.cImagingwithcontrastwhenclinicallyindicated.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version2.2022,9/8/2021©2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.KID-B2OF5KID-B3OF5PrintedbyMinTangon10/4/202110:46:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2021NationalComprehensiveCancerNetwork,Inc.,AllRightsKID-B3OF5dexFOLLOW-UPa,byBFollow-upforStageIIorIII•H&Pevery3–6mofor3y,thenannuallyupto5y,andasclinicallyindicatedthereafter•Comprehensivemetabolicpanelandothertestsasindicatedevery3–6mofor3y,thenannuallyupto5y,andasclinicallyindicatedthereafter•Abdominalimaging:pBaselineabdominalCTorMRIwithin3–6mo,thenCTorMRI(preferred),orUS(USiscategory2BforstageIII),every3–6moforatleast3yandthenannuallyupto5ypImagingbeyond5y:asclinicallyindicated•Chestimaging:pBaselinechestCTwithin3–6mowithcontinuedimaging(CTpreferred)every3–6moforatleast3yandthenannuallyupto5ypImagingbeyond5y:asclinicallyindicatedbasedonindividualpatientcharacteristicsandtumorriskfactors•Additionalimaging(ie,bonescan,brainimaging):pAssymptomswarrantaDonatSM,DiazM,BishoffJT,etal.Follow-upforclinicallylocalizedrenalneoplasms:AUAGuideline.JUrol2013;190:407-416.bNosinglefollow-upplanisappropriateforallpatients.Follow-upfrequencyanddurationshouldbeindividualizedbasedonpatientrequirements,andmaybeextendedbeyond5years(SeeKID-B,5of5).Furtherstudyisrequiredtodefineoptimalfollow-upduration.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version2.2022,9/8/2021©2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon10/4/202110:46:22AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2021NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexFOLLOW-UPyBFollow-upAfterAdjuvantTherapy•Patientswhoreceivedadjuvanttherapyshouldreceiveclinicalfollow-upasforstageIIorIIIdiseaseFollow-upforRelapsedorStageIVandSurgicallyUnresectableDiseasec,d•H&Pevery6–16weeksforpatientsreceivingsystemictherapy,ormorefrequentlyasclinicallyindicatedandadjustedfortypeofsystemictherapypatientisreceiving•Laboratoryevaluationasperrequirementsfortherapeuticagentbeingused•Chest,abdominal,andpelvicimaging:pCTorMRIimagingtoassessbaselinepretreatmentorpriortoobservationpFollow-upimagingevery6–16weeksasperphysiciandiscretion,patientclinicalstatus,andtherapeuticschedule.Imagingintervaltobeadjustedshorterorlongeraccordingtor