Early resection of residual tumor during cisplatin, vinblastine, bleomycin combination chemotherapy in stage III and bulky stage II nonseminomatous testicular cancer

Abstract

Sixty consecutive patients with Stage III or bulky Stage II nonseminomatous germinal testis tumors were treated with cisplatin, vinblastine, bleomycin combination chemotherapy (PVB). One patient died of acute toxicity after the first course of therapy, 16 entered complete remission (CR) after two or three inductions, and 36 underwent surgery for removal of residual masses after the third cycle. No residual tumor was found in 16 cases, 10 had mature teratoma, and residual malignant tumor was completely resected in 8 of 10 patients. On the whole, 52 of 59 cases (88%) who completed the therapy entered CR, 34 (58%) with PVB and 18 (30%) with PVB and resection of the residual disease. The major beneficiaries of surgery were patients with bulky metastases (17 of 45, 38%) and those with primary teratocarcinoma (13 of 24, 54%). All of the patients who entered CR received two additional inductions and no maintenance. After a median follow-up period of greater than 3 years, 40 patients (68%) remain continuously disease-free, 1 died in CR, and 3 of the 11 who had relapse were salvaged. All of the 32 patients with lung deposits less than 5 cm and/or lymph node metastases less than 10 cm entered CR after the combined treatment modality, and 29 (91%) are alive disease-free. Also, 20 of 27 patients (74%) with far-advanced disease (lung and lymph node metastases larger than 5 and 10 cm, respectively, extrapulmonary disease) entered CR after PVB and surgery, but only 11 (41%) are continuously disease-free. Early resection of the residual tumor during PVB combination chemotherapy greatly increased the CR rate, but relapses were very frequent in patients with far-advanced disease.

Cisplatin, etoposide, bleomycin first-line therapy and early resection of residual tumor in far-advanced germinal testis cancer

“…hematologic and gastrointestinal toxicity was much less severe in the PEB series than in a precedent group of patients treated with PVB. 9 Better experience with drugs and disease, appropriate use of surgery, and salvage chemotherapy have improved the overall cure rates of disseminated testicular cancer from 57% to 81% in three consecutive PVB series. '-' But if we look at the cure rates achieved with PVB and surgery alone, we realize that they have reached a plateau at 60% to 70% and that the cure rates of patients with more advanced disease are in the range of 40% to 50%.…”

Extraperitoneal laparoscopic retroperitoneal lymph node dissection in supine position after chemotherapy for advanced testicular carcinoma

“…Originally, complete bilateral resection was considered necessary 13,14 . However, others have proposed excising the only the residual tumor 15–17 . In the present study, the residual masses were not large and patients hoped for normal ejaculation.…”

Post‐chemotherapy nerve‐sparing laparoscopic retroperitoneal lymph node dissection in stage IIB testicular cancer

“…There has been controversy about the resection area for RPLND after chemotherapy. Some authors reported that complete bilateral resection should be necessary, others proposed excising only the residual tumor . Heidenreich et al .…”