Results of Adjuvant Surgery in Patients with Stage III and IV Nonseminomatous Testicular Tumors after Cisplatin-Vinblastine-Bleomycin Chemotherapy

Abstract

patients were treated with cisplatinvinblastine-bleomycin chemotherapy because of advanced nonseminomatous testicular tumor (NSTT). After the chemotherapy, the serum tumor markers were back to normal in 41 patients, of whom 35 were eligible for surgical removal of the residual tumor. In four patients, vital tumor tissue was found in the residual tumor. Salvage chemotherapy resulted in complete remission. Residual mature teratoma was encountered after the chemotherapy in 15 of the 25 patients with a teratomatous component and in one of the ten patients without a teratomatous component in the primary tumor. On completion of the study, 38 of the 53 patients (72%) are still alive, with a median follow-up of 65 months. Subdivided by tumor volume, survival is found to amount to 92% for small-volume disease, 67 % for large-volume disease, and 64 % for very-large-volume disease. Six patients (1 1 %) developed a recurrence in the course of the follow-up. Exploratory laparotomy after remission induction chemotherapy is necessary in all patients with a teratomatous component in the primary testicular tumor who have become tumor marker negative, irrespective of the roentgenographic findings of the retroperitoneum. Patients without a teratomatous component in the primary tumor should have exploratory laparotomy only in case of roentgenographic evidence of retroperitoneal residual tumor. A thoracotomy is needed only in the presence of roentgenographic evidence of pulmonary residual lesions.

Retroperitoneal Metastases in Testicular Cancer: Role of CT Measurements of Residual Masses in Decision Making for Resection after Chemotherapy

“…These characteristics included the histologic findings in the primary tumor (presence of teratoma elements) and the levels of tumor markers AFP, HCG, and LDH before chemotherapy, which were combined in a simple score based on the number of favorable values. The predictive value of these characteristics is well documented (6)(7)(8)(9)(10).…”

“…For the present analysis, we excluded 75 patients for whom measurements of mass size before (n ϭ 52) or after (n ϭ 65) chemotherapy were missing; therefore, data in 641 patients were available for analysis (Table 1). Patients were treated at the Klinikum Grosshadern, Munich, Germany (n ϭ 98 [13]); Memorial Sloan-Kettering Cancer Center, New York, NY (n ϭ 88 [8]); Norwegian Radium Hospital, Oslo (n ϭ 150 [9]); and a number of university hospitals in the Netherlands (Groningen, n ϭ 154; other centers, n ϭ 151 [7,14,15]). …”

“…At all centers, patients were candidates for resection of retroperitoneal lymph nodes if residual masses were depicted on CT scans obtained after chemotherapy; this criterion implied resection of masses equal to or larger than approximately 10 mm. At the University Hospital Groningen, resection was also performed when the primary tumor contained teratomatous elements, even if no residual masses were detectable (7). At the Norwegian Radium Hospital, resection was routinely performed regardless of the size of the mass after chemotherapy (9).…”

“…(presence of teratomatous elements) and levels of tumor markers before chemotherapy, namely, elevated levels of ␣-fetoprotein (AFP), elevated levels of human chorionic gonadotropin (HCG), and normal levels of lactate dehydrogenase (LDH) (6)(7)(8)(9)(10).…”

Resection of residual retroperitoneal masses in testicular cancer: evaluation and improvement of selection criteria

“…A statistical model was developed from this same data set, using several well-known predictors of the histology of residual masses (Tait et al, 1984;Donohue et al, 1987;Gelderman et al, 1988;Harding et al, 1989;Toner et al, 1990;Mulders et al, 1990;Steyerberg et al, 1994;Gerl et al, 1995). Easy-touse alternative selection criteria were based on this analysis and compared with the current policies.…”