The management of residual masses after chemotherapy in metastatic seminoma.
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.
Ravi
R
R
St Bartholomew's and The Royal London Hospital School of Medicine and Dentistry, London, UK.
Ong
J
J
Oliver
R T
RT
Badenoch
D F
DF
Fowler
C G
CG
Hendry
W F
WF
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