Post chemotherapy RPLND in patients with elevated markers: current concepts and clinical outcome.
Elevated serum tumor markers after cisplatin-based chemotherapy usually contraindicate surgery because of the presence of active germ-cell elements; however, some patients have undergone PCRPLND with curative intent. We evaluated the role of surgery to resect retroperitoneal-only marker positive tumor. Residual germ-cell cancer was identified in 50% of patients with elevated tumor markers with one third alive at 5 years; 5-year survival with residual teratoma or necrosis was 77.5% and 85.7%, respectively. Predictors of retroperitoneal teratoma or fibrosis included declining tumor makers at surgery, betaHCG < 100, and first-line chemotherapy. Predictors of death included rising preoperative betaHCG, elevated AFP, redo RPLND, and active germ-cell cancer in the resected specimen. Select patients with elevated tumor markers after chemotherapy are cured with surgery.
Beck
Stephen D W
SD
Department of Urology, Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, IN 46202, USA. sdwbeck@iupui.edu
Foster
Richard S
RS
Bihrle
Richard
R
Einhorn
Lawrence H
LH
Donohue
John P
JP
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000628:therapy; D012187:Retroperitoneal Space / Q000601:surgery*; D013736:Testicular Neoplasms / Q000097:blood / Q000628:therapy; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor