title: Post chemotherapy RPLND in patients with elevated markers: current concepts and clinical outcome.
abstract: 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.
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, IN 46202, USA. sdwbeck@iupui.edu
authors.forename: Stephen D W
authors.initials: SD
authors.lastname: Beck
authors.forename: Richard S
authors.initials: RS
authors.lastname: Foster
authors.forename: Richard
authors.initials: R
authors.lastname: Bihrle
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Einhorn
authors.forename: John P
authors.initials: JP
authors.lastname: Donohue
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor