Surgery as salvage therapy in chemotherapy-resistant nonseminomatous germ cell tumours.
OBJECTIVE
To review our experience of surgical staging for residual masses after chemotherapy in patients with nonseminomatous germ cell tumour (NSGCT) and positive tumour markers.


METHODS
Of 107 patients with metastatic NSGCTs treated surgically after chemotherapy from 1978 to 1995, 30 (median age 30.5 years, range 20-52) had positive tumour markers. These patients were reviewed and the outcome compared with 77 patients who had normal tumour marker values.


RESULTS
Of the 77 patients with negative markers undergoing surgical/pathological staging, 71 (92%) became continuously disease-free, including 37 of 50 (74%) with viable NSGCT in excised specimens. Seventeen of 30 (57%) with raised marker levels undergoing similar surgery for chemotherapy-resistant tumour became disease-free, including 11 of 22 with viable NSGCT in the excised specimens.


CONCLUSIONS
Although the outcome after surgery is better in patients with negative tumour markers, it is clear that surgery is curative for patients with localized chemotherapy-resistant masses. There is a need for continued debate on the timing of salvage surgery and subsequent chemotherapy.
Royal London Hospital School of Medicine and Dentistry, UK.
R
R
Ravi
J
J
Ong
R T
RT
Oliver
D F
DF
Badenoch
C G
CG
Fowler
W F
WF
Hendry
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D005500:Follow-Up Studies; D018237:Germinoma / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D016879:Salvage Therapy / Q000379:methods*; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D016896:Treatment Outcome