Management of post-chemotherapy residual masses in advanced seminoma.
OBJECTIVE
We studied the resection of post-chemotherapy residual masses (20% to 80%) of advanced seminoma complicated by extensive fibrosis, in which active disease appears in 10% to 20% of cases.


METHODS
We retrospectively analyzed (1986 to 2000) residual mass evolution according to size in 79 platinum treated patients.


RESULTS
There was an evaluable response in 78 patients, including toxic death in 1 after 1 chemotherapy cycle, a complete response in 34 (after chemotherapy in 15 and after complete residual mass resection in 19), a marker negative partial response in 42 (incomplete residual mass resection in 8), stable and progressive disease in 1 each. In 15 of 31 patients the resected residual mass was 3 cm. or greater, whereas in 12 of 29 it was less than 3 cm. No surgery was performed for 3 residual masses of unknown size. Of the 42 residual masses 21 disappeared at a median of 12.5 months. Progression occurred at the initial tumor site in 11 of 13 patients after a median of 3.5 months, including 3 with a complete response, 8 with a marker negative partial response (residual mass 3 cm. or greater in 3, less than 3 cm. in 4 and unknown size in 1) and treatment failure in 2 (residual mass 3 cm. or greater). At a median followup of 36.4 months 67 patients survived (no disease progression in 56 and nonevolving residual masses in 11), while 12 had died including 9 of progressive disease 1 of toxicity and 2 of other causes.


CONCLUSIONS
In our study there was incomplete surgical resection in 30% of cases. Relapse in 16.6% of cases occurred rapidly after the end of chemotherapy. Viable cells were only noted in residual masses 3 cm. or greater (13%) and 50% of residual masses disappeared during surveillance. We intend to perform a prospective cohort study with close followup of patients with residual masses less than 3 cm. using an indication for surgery tailored to positron emission tomography findings in those with residual masses 3 cm. or greater.
Flechon
Aude
A
Department of Medical Oncology, Centre Léon Bérnard, Lyon, France.
Bompas
Emmanuelle
E
Biron
Pierre
P
Droz
Jean-Pierre
JP
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018239:Seminoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery