Correlation of Computerized Tomographic Changes and Histological Findings in 80 Patients Having Radical Retroperitoneal Lymph Node Dissection after Chemotherapy for Testis Cancer

Abstract

A total of 80 patients with stage B3 or B2/C germ cell testis tumors underwent computerized tomography before and after chemotherapy. The volume and computerized tomographic density of metastatic retroperitoneal tumor were measured on all scans. The patients then underwent full bilateral retroperitoneal lymphadenectomy. The change in volume and density of retroperitoneal disease was correlated with the histological type of the primary testis tumor and with the histological findings at retroperitoneal lymphadenectomy. In all 15 patients (100 per cent) without teratomatous elements in the original tumor and who had a greater than 90 per cent decrease in the volume of retroperitoneal masses as a response to systemic chemotherapy no teratoma or active cancer was found in the surgical specimen. In contrast, 7 of 9 patients (78 per cent) with teratomatous elements in the original specimen had either teratoma or carcinoma in the retroperitoneal lymphadenectomy specimens despite having a greater than 90 per cent decrease in tumor volume. This difference was significant (p less than 0.05). These data suggest that patients with no teratomatous elements in the original specimen and a greater than 90 per cent decrease in the volume of retroperitoneal masses in response to chemotherapy can be observed carefully for signs of recurrence rather than undergoing post-chemotherapy retroperitoneal lymphadenectomy.

Prognosis after resection of residual masses following chemotherapy for metastatic nonseminomatous testicular cancer: a multivariate analysis

“…Large European studies reported 31% (Dearnaley et al, 1991) and 20% (Mead et al, 1992), reflecting the policy to resect CT-detectable residual masses only if these exceed an arbitrarily chosen size. Further, subsets of patients have been defined (Donohue et al, 1987;Fossa et al, 1992), for whom the mortality and morbidity of resection may not be balanced by the small risk of leaving tumour unresected.…”

“…If residual masses are detected after chemotherapy, surgical resection is usually performed (Donohue & Rowland, 1984), although no general agreement exists whether all patients should be operated on (Levitt et al, 1985;Donohue et al, 1987;Fossa et al, 1992). Additional chemotherapy is usually given if viable cancer cells are present in the resected specimens, to kill remaining microscopic disease (Donohue & Rowland, 1984).…”

The significance of resections for residual masses after chemotherapy in metastatic testicular tumors

“…1,2 When residual masses are detected after chemotherapy, surgical resection is usually performed, 3 although no general agreement exists about whether all patients should be operated on. [4][5][6] The extent of surgery is also debatable; some excise only visible abnormal masses, 7 whereas others perform a more extensive retroperitoneal lymph nodes dissection. 8 Pathology of resected masses may reveal necrosis/fibrosis, mature teratoma, or cancer and additional chemotherapy is usually given to kill the remaining microscopic disease when viable cancer cells are present in the resected specimens.…”

Long-term follow-up of residual masses after chemotherapy in patients with non-seminomatous germ cell tumours

“…Treatment strategies have included surgery (usually retroperitoneal lymph node dissection (RPLND)) in all patients including those with radiological CR (Gelderman et al, 1986;Fossa et al, 1989;Aass et al, 1991), surgical intervention in those with residual masses only (Donohue and Rowland, 1984;Steyerberg et al, 1993) or resection in a selected group of patients with residual masses (Levitt et al, 1985;Hendry et al, 1993;Debono et al, 1997). Criteria proposed and used for selection of these patients have included the size of the mass, the degree of shrinkage of the mass with chemotherapy, degree of further shrinkage after chemotherapy and the histology of the primary tumour (Levitt et al, 1985, Donohue et al, 1987, Fossa et al, 1992, Hendry et al, 1993, Jaeger et al, 1994, Debono et al, 1997. This is based on work by authors examining the correlation between various factors and the histology of the residual mass.…”

“…This is based on work by authors examining the correlation between various factors and the histology of the residual mass. These factors have included the primary histology, marker levels, the pre-and post-chemotherapy mass size, site of the mass and the attenuation of the mass on computerized tomographic scanning (CT) and statistical models have been developed to try to predict the histology of masses post-chemotherapy (Gelderman et al, 1986;Donohue et al, 1987;Sagalowsky et al, 1990;Stomper et al, 1991;Steyerberg et al, 1994Steyerberg et al, , 1995Rabbani et al, 1996). The rationale behind this is that historically the histology of the resected material has consisted of necrosis/fibrosis in 18-49%, differentiated teratoma (TD) in 30-57% and malignancy in up to 30% (Bajorin et al, 1992;Christmas et al, 1998a).…”