Treatment of retroperitoneal residual tumor after PVB chemotherapy of nonseminomatous testicular tumors

Abstract

Twenty-five patients with nonseminomatous testicular tumors stages IIB and IIC were treated at the Groningen University Hospital between January 1978 and April 1983. One patient died from his extensive tumor during chemotherapy. The remaining 24, treated by combination chemotherapy with cisplatin, vinblastine, and bleomycin as well as by surgery, are all alive after a mean follow-up period of 56 months. A laparotomy was performed after chemotherapy in each of the 24 cases. In four patients no residual tumor was found. Residual tumor was resected in 20 patients, in 13 the tumor contained only necrosis and fibrosis, 7 had mature teratoma. Comparison of the histologic features of the primary testicular tumor with those of the retroperitoneal residual tumor after chemotherapy, revealed that if the primary tumor did not contain a teratoma component the residual tumor showed only necrosis and/or fibrosis. When the primary tumor contained a teratoma component, mature teratoma was found in 50% (7/14) of the residual tumors.

Retroperitoneal lymphadenectomy by videolaparoscopic transperitoneal approach in patients with non-siinomatous testicular tumor

“…The laparoscopic surgery has lower morbidity when compared with open surgery and some studies show that there is no impairment in the oncologic control of the disease (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12).…”

“…Pathological staging of retroperitoneal lymph nodes in patients with non-seminomatous tumors offers 2 advantages: patients with metastatic disease can be identified and treated, and those without metastatic disease can be closely observed (1,11,12).…”

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

“…However, there is no clear consensus as to the management of patients with serological CR. Treatment strategies have included surgery (usually retroperitoneal lymph node dissection (RPLND)) in all patients including those with radiological CR (Gelderman et al, 1986;Fossa et al, 1989;Aass et al, 1991), surgical intervention in those with residual masses only (Donohue and Rowland, 1984;Steyerberg et al, 1993) or resection in a selected group of patients with residual masses (Levitt et al, 1985;Hendry et al, 1993;Debono et al, 1997). Criteria proposed and used for selection of these patients have included the size of the mass, the degree of shrinkage of the mass with chemotherapy, degree of further shrinkage after chemotherapy and the histology of the primary tumour (Levitt et al, 1985, Donohue et al, 1987, Fossa et al, 1992, Hendry et al, 1993, Jaeger et al, 1994, Debono et al, 1997.…”

“…This is based on work by authors examining the correlation between various factors and the histology of the residual mass. These factors have included the primary histology, marker levels, the pre-and post-chemotherapy mass size, site of the mass and the attenuation of the mass on computerized tomographic scanning (CT) and statistical models have been developed to try to predict the histology of masses post-chemotherapy (Gelderman et al, 1986;Donohue et al, 1987;Sagalowsky et al, 1990;Stomper et al, 1991;Steyerberg et al, 1994Steyerberg et al, , 1995Rabbani et al, 1996). The rationale behind this is that historically the histology of the resected material has consisted of necrosis/fibrosis in 18-49%, differentiated teratoma (TD) in 30-57% and malignancy in up to 30% (Bajorin et al, 1992;Christmas et al, 1998a).…”

“…Some advocate observation if initial chemotherapy leads to >90% radiological regression (Gelderman et al, 1986). The policy at Mount Vernon Hospital has been that patients with serological and radiological CR have not been submitted to routine RPLND.…”