Postchemotherapy residual masses in germ cell tumor patients: our experience.
BACKGROUND
The nature of post-chemotherapy tumor residuals can be determined only by excision and histological examination, but at present no consensus has been reached as to whether all patients with residual masses should undergo adjunctive surgery.


METHODS
Between August 1991 and September 2004, 120 patients with metastatic germ cell tumors were diagnosed at our hospital and 35 of these patients (30%) underwent adjunctive surgery after cisplatin-based chemotherapy. If serum tumor markers were still raised salvage chemotherapy was administered.


RESULTS
At the time of surgical intervention 30 patients (86%) had a partial remission with normal markers. Necrosis, differentiated teratoma and undifferentiated tumor were found in nine (30%), 19 (63%) and two (7%) of all patients. Five patients (14%) underwent postchemotherapy resections after second-line cisplatin-based combination chemotherapy. Four of the 35 patients died as a result of their malignant germ cell tumor. The median observation time after the initial diagnosis was 99 months (range 15-172 months).


CONCLUSIONS
Secondary resection of residual masses after first or second-line chemotherapy is still an essential part of the treatment of metastatic testicular cancer. Resection of mature teratoma or viable cancer adds to long-term event-free and overall survival in these patients.
Morelli
F
F
Department of Onco-Hematology, Oncology Unit, Department of Surgery Sciences, Urology Unit and Pathology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy. e.maiello@operapadrepio.it
Tozzi
L
L
Setola
P
P
Bisceglia
M
M
Barbini
V Ricci
VR
Maiello
E
E
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery
D002945:Cisplatin