title: Surgical resection of solitary metastases after chemotherapy in patients with nonseminomatous germ cell tumors and elevated serum tumor markers.
abstract: BACKGROUND
  Chemorefractory metastatic germ cell tumors and elevated tumor markers generally indicate inoperable disease.
  
  
  METHODS
  Solitary metastases were resected in 15 patients who had a nonseminomatous germ cell tumor and an elevated alpha-fetoprotein (AFP) and/or human chorionic gonadotropin (HCG) serum level after treatment with cisplatin-based chemotherapy. Patients underwent resection for a residual mass after chemotherapy or for a new solitary metastasis after achieving a complete response (CR) to salvage chemotherapy.
  
  
  RESULTS
  Seven patients were disease-free after surgical resection alone. All five patients with an elevated HCG level had a relapse after surgery compared with 3 of 10 patients with only an elevated AFP level. Only 4 of 10 patients with a retroperitoneal metastasis had a relapse after surgery compared with 4 of 5 patients with visceral disease. Eleven of 15 patients overall were disease-free after surgery and subsequent chemotherapy after a relapse.
  
  
  CONCLUSIONS
  Surgical resection of a solitary metastasis despite elevated serum tumor markers should be considered in patients who have not had a durable CR to cisplatin-based chemotherapy.
authors.affiliation: Urology Service (Department of Surgery), Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
authors.forename: D P
authors.initials: DP
authors.lastname: Wood
authors.forename: H W
authors.initials: HW
authors.lastname: Herr
authors.forename: R J
authors.initials: RJ
authors.lastname: Motzer
authors.forename: V
authors.initials: V
authors.lastname: Reuter
authors.forename: P C
authors.initials: PC
authors.lastname: Sogani
authors.forename: M J
authors.initials: MJ
authors.lastname: Morse
authors.forename: G J
authors.initials: GJ
authors.lastname: Bosl
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood*; D017024:Chemotherapy, Adjuvant; D006063:Chorionic Gonadotropin / Q000097:blood*; D002945:Cisplatin / Q000008:administration & dosage; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D011379:Prognosis; D012074:Remission Induction; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D016879:Salvage Therapy; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D014408:Biomarkers, Tumor; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D002945:Cisplatin; D007069:Ifosfamide