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Interesting case and thank you for sharing. He has late recurrence after 5 years, which could be predictive marker for better DFS, OS, with sunitinib treatment as reported in the retrospective study by o Bozkurt et al. The goal of therapy still aiming for curing, and cancer free. He has RLL and would consider RFA / SBRT of the lung metastatic lesion. Stewart Merill et al in JCO reported approach to RCC surveillance that bases the duration of follow-up on the interplay between competing risk factors of recurrence and non-RCC death. This strategy may improve the balance between the derived benefit from surveillance and medical resource allocation. Given his prognostic risk stratification and co-morbidities including his age, the Non renal cell carcinoma mortality higher than his recurrence rate. So I would not feel strongly about adjuvant systemic therapy, especially no RTC or clear evidence data.
Why not assess lung nodule resection and surveillance follow-up?
Pending Moderator approval.
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