title: Aggressive multimodal therapy may prolong disease-free survival in recurrent primary retroperitoneal embryonal carcinoma.
abstract: BACKGROUND
  Primary retroperitoneal extragonadal tumours relapsing after initial chemotherapy have a poor prognosis.
  
  
  METHODS
  We report a case of primary retroperitoneal embryonal carcinoma in a patient with negative open testes biopsy. After the first line of chemotherapy (4 cycles BEP) secondary surgery with extirpation of a retroperitoneal residual mass was performed. The residuum proved histologically to be a mature teratoma, and no adjuvant treatment was given according to current recommendations. The patient had regular follow-up. 3.5 years later, patient developed recurrence in the ipsilateral adrenal gland, which was treated with surgery and 4 cycles of salvage VeIP chemotherapy. Seven months after the second surgical intervention the patient underwent multivisceral "desperation surgery" for early metastatic disease progression followed by 2 cycles of salvage TIP chemotherapy. The patient is currently disease-free at 34 months.
  
  
  CONCLUSIONS
  Initial postchemotherapy retroperitoneal lymph node dissection is crucial for local retroperitoneal disease control. Aggressively treated metastatic recurrent disease does not preclude prolonged survival. Despite a generally poor prognosis, repeated complex oncosurgical therapy for retroperitoneal extragonadal tumours may be worthwhile.
authors: Department of Surgery, Comprehensive Cancer Centre and AGEL Research and Training Institute, Novy Jicin Hospital, Purkynova 2138-16, 741 01 Novy Jicin Czech Republic. Electronic address: tulakmato@gmail.com.
authors: Martin
authors: M
authors: Straka
authors: Department of Oncology and Radiotherapy, Comprehensive Cancer Centre and AGEL Research and Training Institute, Novy Jicin Hospital, Czech Republic.
authors: Viktor
authors: V
authors: Manasek
authors: Department of Urology, Comprehensive Cancer Centre and AGEL Research and Training Institute, Novy Jicin Hospital, Czech Republic.
authors: Miroslav
authors: M
authors: Stursa
authors: Department of Pathology, Comprehensive Cancer Centre and AGEL Research and Training Institute, Novy Jicin Hospital, Czech Republic.
authors: Romana
authors: R
authors: Andelova
keywords: Adjuvant therapy; Extragonadal; Germ cell tumour; Recurrence; Relapse; Surgery