title: Contemporary management of postchemotherapy testis cancer.
abstract: BACKGROUND
  Some controversy still exists regarding the management of testis cancer following chemotherapy for disseminated disease.
  
  
  OBJECTIVE
  To review the available literature concerning the management of postchemotherapy testis cancer.
  
  
  METHODS
  A Medline search was conducted to identify original and review articles, as well as guidelines addressing the management of testis cancer following first-line chemotherapy. Keywords included germ cell tumor, testis cancer, retroperitoneal lymph node dissection, and chemotherapy. The most relevant articles were critically reviewed with the consensus of all the collaborative authors, who have expertise in the management of germ cell tumors (GCTs).
  
  
  RESULTS
  Approximately one-third of patients who undergo chemotherapy for metastatic GCTs have residual retroperitoneal disease. All patients with residual masses ≥1cm after chemotherapy for nonseminomatous GCTs should undergo postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) because of the risk of mature teratoma in 40-45% of cases and of viable GCT in 10-15% of cases. Patients who obtain a complete serologic remission and radiographic residual <1 cm after chemotherapy have a 6-9% risk of relapse. Patients with a completely resected teratoma in only the PC-RPLND specimen have a >90% chance of cure, while patients with viable GCTs should be considered for additional therapy, depending on the percentage of viable tumor. In patients with disseminated seminoma, postchemotherapy masses <3cm may be safely observed, while patients with masses >3 cm should be evaluated with positron emission tomography (PET)/computed tomography 2 mo after completion of chemotherapy, with very selective administration of PC-RPLND. Late relapse occurring >2 yr after chemotherapy is rare, and surgery remains the mainstay of therapy in cases of resectable masses independent of tumor markers. There is still controversy on whether high-dose chemotherapy confers a survival benefit compared with conventional-dose chemotherapy in the salvage setting. Surgery should always be considered for resectable masses following salvage therapies or in chemoresistant disease to maximize chance of cure.
  
  
  CONCLUSIONS
  Patients with advanced GCTs can achieve long-term disease-free survival when chemotherapy is combined with expert and judicious resection of residual disease. PC-RPLND is recommended for residual masses >1cm identified on postchemotherapy imaging in nonseminomatous GCT and possibly for PET-positive residual disease ≥3cm in treated seminomas.
authors.affiliation: University of Southern California, Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA 90089, USA. daneshma@usc.edu
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
authors.forename: Peter
authors.initials: P
authors.lastname: Albers
authors.forename: Sophie Dorothea
authors.initials: SD
authors.lastname: Fosså
authors.forename: Axel
authors.initials: A
authors.lastname: Heidenreich
authors.forename: Christian
authors.initials: C
authors.lastname: Kollmannsberger
authors.forename: Susan
authors.initials: S
authors.lastname: Krege
authors.forename: Craig
authors.initials: C
authors.lastname: Nichols
authors.forename: Jan
authors.initials: J
authors.lastname: Oldenburg
authors.forename: Lori
authors.initials: L
authors.lastname: Wood
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018572:Disease-Free Survival; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents