title: The management of residual masses after chemotherapy in metastatic seminoma.
abstract: OBJECTIVE
  To review our experience in management of residual masses after chemotherapy for metastatic seminoma.
  
  
  METHODS
  The study comprised a review of 107 patients with metastatic seminoma, treated with initial chemotherapy from 1978 to 1996. Forty-three patients had residual masses detected by computed tomography after chemotherapy, while 64 achieved a complete response. Residual masses were classified radiologically as <3 cm or >/=3 cm and as well- or poorly defined. Of the patients with residual masses, 19 underwent surgery, while 24 were observed.
  
  
  RESULTS
  Viable cancer was present in six of 11 patients with well-defined residual masses of >/=3 cm (positive histology in three of six undergoing surgery and site relapses in three of five observed), one of 14 patients with poorly defined masses of >/=3 cm (negative histology in nine undergoing surgery and site relapse in one of five observed), and in none of 17 patients with residual masses of <3 cm (negative histology in four undergoing surgery and no site relapses in 13 observed; one additional patient in this group died from treatment complications).
  
  
  CONCLUSIONS
  Patients with a complete response after chemotherapy, a residual mass of <3 cm and a poorly defined residual mass of >/=3 cm can be observed, reserving intervention for recurrent or progressive disease. Well-defined residual masses of >/=3 cm should be resected because there is a 55% likelihood of persistent tumour.
authors.affiliation: St Bartholomew's and The Royal London Hospital School of Medicine and Dentistry, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Ravi
authors.forename: J
authors.initials: J
authors.lastname: Ong
authors.forename: R T
authors.initials: RT
authors.lastname: Oliver
authors.forename: D F
authors.initials: DF
authors.lastname: Badenoch
authors.forename: C G
authors.initials: CG
authors.lastname: Fowler
authors.forename: W F
authors.initials: WF
authors.lastname: Hendry
mesh_terms: D006801:Humans; D008297:Male; D018365:Neoplasm, Residual; D018239:Seminoma / Q000188:drug therapy* / Q000556:secondary; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology; D014057:Tomography, X-Ray Computed