[In which marker-positive patients with germ cell tumors is residual tumor resection of value?].
We analyzed 33 patients with disseminated germ cell tumors (GCT) who underwent residual tumor resection (RTR) during the period from 1991-1997. The patients were marker positive prior to surgery were analyzed. The histopathological examination of the resected masses, the marker dynamics and the relapse-free respectively the progression free survival, were evaluated. The status differed at primary diagnosis: minimal disease n = 1, moderate disease n = 15, advanced disease n = 17. The patients received at average 8.5 cisplatin-containing cycles of polychemotherapy. Only 11 patients underwent surgery after first-line-chemotherapy. The remaining received second- or third-line-chemotherapy prior to surgery. In 12 of 31 evaluable patients, a durable CR was achieved. The median follow-up for this group is 30 months (2-58 months). The histopathologic examination of the resected specimen and the tumor marker level prior to RTR do not permit determination of prognostic outcome. After operation 44% of the AFP-positive and 30% of the beta-HCG-positive patients had a durable remission. If tumor marker levels at time of RTR are within normal range, disease-free survival is 72%; in case of elevated markers 39% will survive. If intensive chemotherapy fails to normalize markers, RTR remains the only option to change the fatal course of the disease.
Weinknecht
S
S
Urologische Abteilung, Krankenhaus Am Urban, Berlin.
Hartmann
M
M
Weissbach
L
L
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D017024:Chemotherapy, Adjuvant; D006063:Chorionic Gonadotropin / Q000097:blood; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D018365:Neoplasm, Residual / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D000509:alpha-Fetoproteins / Q000378:metabolism
D014408:Biomarkers, Tumor; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins