Prediction of Necrosis After Chemotherapy of Advanced Germ Cell Tumors: Results of a Prospective Multicenter Trial of the German Testicular Cancer Study Group

Abstract

Patients with pure seminoma should not undergo residual tumor resection because 97% of patients who received adequate chemotherapy were found to have no residual seminoma. In cases of nonseminoma alpha-fetoprotein values before chemotherapy less than 20 ng/ml and a high percentage of shrinkage during chemotherapy reliably predicted only 19% of cases of necrosis. Therefore, this model is clinically irrelevant and patients with minimal residual disease should undergo surgery. New methods are necessary to improve the preoperative selection of patients after chemotherapy.

Canadian consensus guidelines for the management of testicular germ cell cancer

“…153,154 In patients with residual masses less than 3 cm, the likelihood of viable malignancy is low and thus surveillance is reasonable. [155][156][157] In patients with residual masses less than <3 cm, the use of FDG-PET scanning is optional. The PET scan should be done 4 to 12 weeks after day 21 of the last chemotherapy cycle.…”

Diagnostic Accuracy of 18F-FDG-PET in Patients with Testicular Cancer: a Meta-analysis

“…And another possible reason for false-positive is nonspecific inflammatory processes after chemotherapy Tsatalpas et al, 2002;Albers et al, 2004;Johns Putra et al, 2004). In this regard, it might be of principal importance that we should do the examination before chemotherapy or have an interval of at least 4 weeks after chemotherapy (De Santis et al, 2004;Becherer et al, 2005).…”

Validation of a prediction model for avoiding post-chemotherapy retroperitoneal lymphadenectomy in patients with metastatic nonseminomatous germ cell cancer

“…14 This surgery has risks and may have long-term effects on patients' health, and is unnecessary in the 40% of cases with only benign pathological findings. 8 Several approaches to more precisely applying RPLND in this setting have been suggested, including size parameters of the retroperitoneal mass.…”