Postchemotherapy Residual Masses in Germ Cell Tumor Patients. Content, Clinical Features, and Prognosis

Stenning, Sally; Parkinson, M. C.; Fisher, Cyril; Mead, G. M.; Cook, Pat; Fosså, S. D.; Horwich, A.; Jones, William G.; Newlands, E. S.; Oliver, R.T.D.; Stenwig, Anna E.; Wilkinson, Peter M

doi:10.1016/s0022-5347(05)68882-9

Cited by 22 publications

(26 citation statements)

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“…The most common surgical approach, RPLND, is not without risk, however, and longterm morbidity is common even in experienced hands. The histology of resected residual tissue in the surgery group presented here (differentiated teratoma 50%, necrosis/fibrosis 31.75%, active cancer 18.75%) is similar in content to two recently published large combined series (Steyerberg et al, 1997;Stenning et al, 1998). Overall and progression-free survival curves were also similar.…”

Section: Discussionsupporting

confidence: 74%

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

et al. 2000

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Summary This retrospective study was undertaken to determine the outcome of patients with non-seminomatous germ cell tumour who achieved a serological complete response but who had residual radiologic abnormalities upon completion of primary platinum-based chemotherapy. This was an analysis of 76 consecutive patients treated at Mount Vernon Hospital between 1983 and 1997. The patients were placed into two groups based upon whether they had surgical resection (surgery group, 48 patients) or observation (observation group, 28 patients) of residual radiologic masses on completion of initial chemotherapy (to enter the surgery group, complete surgical resection must have been achieved). The primary end-points were progression-free and overall survival. The percentage of patients alive with median followup 66 months was 90% for the surgery group and 80% for the observation group (P = 0.53, not significant). The percentage of patients continuously disease-free was 70% in the surgery group and 80% in the observation group (P = 0.31, not significant). In the small sub-group of patients with differentiated teratoma (TD) in the primary lesion who were observed, there was no excess risk of relapse or death. Patients who achieve a serological complete response after primary chemotherapy, but are left with ≤ 2 cm radiological masses that are not cystic and have responded, can be safely observed with diligent follow-up.

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Section: Discussionsupporting

confidence: 74%

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

et al. 2000

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“…18 Review of the RPLND specimens demonstrated that 19.4% of patients had viable tumor in the surgical specimens, with a similar distribution of teratoma, fibrosis, and viable tumor, to what has previously been reported. 8,10,19 Of those with viable tumor in the surgical specimen, 38 patients received adjuvant chemotherapy; however, 27% of these patients died of disease.…”

Section: Discussionmentioning

confidence: 99%

Predictors of outcome in patients undergoing postchemotherapy retroperitoneal lymph node dissection for testicular cancer

Spiess

Brown

Liu

et al. 2006

Cancer

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BACKGROUNDThe management of metastatic nonseminomatous germ cell tumors (NSGCT) frequently consists of systemic chemotherapy followed by retroperitoneal lymph node dissection (PC‐RPLND). The aim of the present study was to evaluate the authors' PC‐RPLND experience and identify predictors of outcome in these patients.METHODSBetween 1980 and 2003, 236 patients with clinical Stage IIA‐III NSGCT underwent PC‐RPLND. Their medical records were retrospectively reviewed for pertinent clinical and treatment‐related outcomes. The 5‐year disease‐specific and recurrence‐free survival was 85% and 75%, respectively, with the median length of follow‐up after RPLND 45 months (6–250 months).RESULTSThe median age of patients at diagnosis was 28 years, with all patients receiving systemic chemotherapy (median of 5 cycles) before RPLND. On multivariate analysis, predictors of poorer disease‐specific survival (DSS) included systemic symptoms at presentation (P = .05), elevated pre‐RPLND serum alpha fetoprotein (AFP, P = .006) and β‐human chorionic gonadotropin (HCG, P = .004), postoperative complications (P = .03), and recurrence (P < .0001). Predictors of poorer recurrence‐free survival (RFS) included advanced clinical stage (IIC‐III, P = .001) and presence of viable tumor in the RPLND specimen (P = .03). A pre‐RPLND serum AFP > 9 ng/mL and HCG > 4.1 mIU/mL were found to predict a worse DSS (P = .03 and .03, respectively).CONCLUSIONSIn patients undergoing PC‐RPLND, preoperative tumor markers and the occurrence of postoperative complications or recurrence are predictive of poorer DSS. Advanced clinical stage and viable tumor in the surgical specimen predict worse RFS. Cancer 2006. © 2006 American Cancer Society.

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“…Whatever the extent of surgery, complete resection of the residual masses impacts prognosis and every attempt at complete surgical resection must be made. 126,132,143 If technically possible, a nerve-sparing procedure should be done. Surgery should be performed by trained, experienced, expert uro-oncologists which may require referral to specialist centre.…”

Section: Post-chemotherapy Residual Masses: Nonseminomatous Germ Cellmentioning

confidence: 99%

Canadian consensus guidelines for the management of testicular germ cell cancer

Wood

Kollmannsberger

Jewett

et al. 2013

CUAJ

123

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Postchemotherapy Residual Masses in Germ Cell Tumor Patients. Content, Clinical Features, and Prognosis

Cited by 22 publications

References 0 publications

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

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

Predictors of outcome in patients undergoing postchemotherapy retroperitoneal lymph node dissection for testicular cancer

Canadian consensus guidelines for the management of testicular germ cell cancer

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