title: Postchemotherapy retroperitoneal surgery remains necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses.
abstract: OBJECTIVE
  To determine preoperative parameters that predict the histology of specimens obtained by retroperitoneal lymph node dissection (RPLND) in patients with nonseminomatous germ cell cancer (NSGCT) whose residual mass was </= 20 mm in diameter after modern cisplatin-based induction chemotherapy.
  
  
  METHODS
  Eighty-seven patients with metastatic NSGCT underwent RPLND after having received cisplatin- or carboplatin-based induction chemotherapy. In all patients, the largest diameter of the residual mass on the transaxial plane was </= 20 mm, as assessed by abdominal computed tomography (CT) immediately before RPLND.
  
  
  RESULTS
  Complete fibrosis or necrosis was found in 58 patients (67%), teratoma was found in 23 patients (26%), and vital malignant germ cell tumor was found in six patients (7%), including one patient with rhabdomyosarcoma in the RPLND specimen. In five of the six latter patients, the residual lesion was </= 10 mm at pre-RPLND CT. No pre- or postchemotherapy clinical or radiologic parameter was identified that significantly predicted the histology of the residual mass.
  
  
  CONCLUSIONS
  One third of retroperitoneal postchemotherapy lesions </= 20 mm contained residual vital tumor tissue, despite modern chemotherapy regimens. Therefore, postchemotherapy RPLND remains necessary in patients with minimal-size residual lesions to facilitate easy and safe follow-up and initiate additional therapy as early as possible, thus avoiding recurrences.
authors.affiliation: Department of Medical Oncology, The Norwegian Radium Hospital, Montebello, Oslo, Norway.
authors.forename: Jan
authors.initials: J
authors.lastname: Oldenburg
authors.forename: G Cecilie
authors.initials: GC
authors.lastname: Alfsen
authors.forename: Hans H
authors.initials: HH
authors.lastname: Lien
authors.forename: Nina
authors.initials: N
authors.lastname: Aass
authors.forename: Håkon
authors.initials: H
authors.lastname: Waehre
authors.forename: Sophie D
authors.initials: SD
authors.lastname: Fossa
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D016190:Carboplatin / Q000008:administration & dosage; D016009:Chi-Square Distribution; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D010537:Peritoneum; D018709:Statistics, Nonparametric; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D001761:Bleomycin; D005047:Etoposide; D016190:Carboplatin; D002945:Cisplatin; D007069:Ifosfamide