Histology of Tumor Residuals Following Chemotherapy in Patients with Advanced Nonseminomatous Testicular Cancer

Abstract

A total of 111 patients with advanced nonseminomatous testicular cancer underwent cisplatin-based combination chemotherapy, followed by surgical removal of residual masses in 101. Surgery included retroperitoneal lymph node dissection in 92 patients, thoracotomy in 19 and hepatic resection in 1 (11 patients underwent 2 operations). Complete necrosis and/or fibrosis was found in 52 operative specimens, mature teratoma in 37 and vital malignant tumor in 12. Of the 11 patients who underwent 2 operations 4 had complete necrosis and/or fibrosis in both histological specimens. After a median observation of 55 months 83 of 89 patients with complete necrosis and/or fibrosis or mature teratoma were without evidence of disease. Only 7 of 12 patients with vital malignant tumor in the operative specimen survived without evidence of disease. Relapses were observed in 16 patients, 4 of them in the retroperitoneal space. Of the 16 relapses 5 were in 12 patients with residual vital malignant tumor, 5 in 37 patients with post-chemotherapy mature teratoma and 4 in 52 patients with complete necrosis and/or fibrosis after chemotherapy. Two patients with recurrence did not undergo an operation. In patients in whom post-chemotherapy retroperitoneal lymph node dissection is considered complete necrosis and/or fibrosis can be predicted by the combination of several factors, including absence of teratomatous elements in the testicular tumor, complete response on post-chemotherapy computerized tomography, and normal alpha-fetoprotein and human chorionic gonadotropin levels after chemotherapy (sensitivity 83%, specificity 76% and correctly predicted 79%). With the knowledge of these factors it seems possible to omit post-chemotherapy retroperitoneal lymph node dissection in approximately 20% of the patients with advanced metastatic nonseminomatous testicular cancer with initial retroperitoneal tumors.

Complications of the post‐chemotherapy resection of retroperitoneal residual tumour mass in patients with

“…be more complicated than it would otherwise have been shortly after the completion of chemotherapy. Finally, As histology determines the need for resection, attempts have been made to predict the histology after leaving masses with residual cancer unresected is a serious risk; the presence of viable cancer cells in the chemotherapy [23][24][25]. Steyerberg et al [25] found that the predictors of necrosis were the absence of teratoma residual mass determines the decision to administer additional chemotherapy [14].…”

Prospective comparison of [18F]fluorodeoxyglucose positron emission tomography with conventional assessment by computed tomography scans and serum tumor markers for the evaluation of residual masses in patients with nonseminomatous germ cell carcinoma

“…20,21 Because approximately 50% of all residual masses contain necrosis only, many patients do not benefit from postchemotherapy surgical resection. 4,[21][22][23] Although surgical morbidity and mortality rates have been reduced substantially during the past decade, the ability to identify these patients with necrotic residual lesions …”

Optimal management of testicular cancer: from self-examination to treatment of advanced disease

“…[21][22][23] The targeted field is defined by the upper edge of thoracic vertebra 11 and the lower edge of lumbar vertebra 5. Ipsilateral to the primary tumor, the lateral margin should extend to the renal hilum and the contralateral margin includes the processus transversus of the lumbar vertebrae.…”