Journal of Clinical Oncology, Vol 10, 569-573, Copyright © 1992 by American Society of Clinical Oncology
Is postchemotherapy retroperitoneal surgery necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses?
SD Fossa, H Qvist, AE Stenwig, HH Lien, S Ous and KE Giercksky
Department of Medical Oncology, Norwegian Radium Hospital, Oslo.
PURPOSE: At least one third of the patients with metastatic testicular
cancer are rendered tumor-free by cisplatin-based chemotherapy. One may
question, therefore, the routine use of postchemotherapy retroperitoneal
lymph node dissection (RLND), especially if the residual masses are less
than 20 mm in diameter. To define the role of such surgery, we analyzed the
postchemotherapy histology in testicular cancer patients with minimal
residual disease. PATIENTS AND METHODS: Seventy-eight patients with
advanced nonseminomatous testicular cancer underwent RLND after three to
four cycles of cisplatin- or carboplatin- based chemotherapy. In all
patients, the largest diameter of the residual retroperitoneal mass was
less than 20 mm. RESULTS: Complete fibrosis/necrosis was found in 51
patients, mature teratoma in 22, and vital malignant germ cell tumor in
five. In two of the latter five patients, alphafetoprotein (AFP) had
increased immediately before RLND. In the 76 patients with normal pre-RLND
tumor markers, the presence of undifferentiated malignant teratoma (MTU) in
the primary tumor and normal prechemotherapy tumor markers were independent
parameters predicting complete fibrosis/necrosis, which was demonstrated in
all 15 patients with these two pretreatment parameters. CONCLUSIONS:
Postchemotherapy RLND can be omitted in patients with MTU in the primary
tumor who have normal AFP/human chorionic gonadotropin (AFP/HCG) before
chemotherapy and whose residual retroperitoneal mass is less than 20 mm in
diameter. If the pre-RLND tumor markers are normal, RLND should be
performed in all other patients with small residual masses, even in the
presence of a normal computed tomography (CT) and particularly if regular
follow-up of the patients is not guaranteed.
This article has been cited by other articles:
|
|
|
|
 
B. S. Carver, B. Shayegan, S. Eggener, J. Stasi, R. J. Motzer, G. J. Bosl, and J. Sheinfeld
Incidence of Metastatic Nonseminomatous Germ Cell Tumor Outside the Boundaries of a Modified Postchemotherapy Retroperitoneal Lymph Node Dissection
J. Clin. Oncol.,
October 1, 2007;
25(28):
4365 - 4369.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. S. Carver, B. Shayegan, A. Serio, R. J. Motzer, G. J. Bosl, and J. Sheinfeld
Long-Term Clinical Outcome After Postchemotherapy Retroperitoneal Lymph Node Dissection in Men With Residual Teratoma
J. Clin. Oncol.,
March 20, 2007;
25(9):
1033 - 1037.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Oldenburg, J. M. Martin, and S. D. Fossa
Late Relapses of Germ Cell Malignancies: Incidence, Management, and Prognosis
J. Clin. Oncol.,
December 10, 2006;
24(35):
5503 - 5511.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. S. Carver and J. Sheinfeld
Germ Cell Tumors of the Testis
Ann. Surg. Oncol.,
November 1, 2005;
12(11):
871 - 880.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Vergouwe and E. W. Steyerberg
Minimal Residual Tumor Masses in Nonseminomatous Testicular Cancer: Surgery or Surveillance?
J. Clin. Oncol.,
June 1, 2005;
23(16):
3853 - 3853.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Oldenburg, G. C. Alfsen, H. H. Lien, N. Aass, H. Waehre, and S. D. Fossa
Postchemotherapy Retroperitoneal Surgery Remains Necessary in Patients With Nonseminomatous Testicular Cancer and Minimal Residual Tumor Masses
J. Clin. Oncol.,
September 1, 2003;
21(17):
3310 - 3317.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Fizazi, S. Tjulandin, R. Salvioni, J. R. Germa-Lluch, J. Bouzy, D. Ragan, C. Bokemeyer, A. Gerl, A. Flechon, J. S. de Bono, et al.
Viable Malignant Cells After Primary Chemotherapy for Disseminated Nonseminomatous Germ Cell Tumors: Prognostic Factors and Role of Postsurgery Chemotherapy--Results From an International Study Group
J. Clin. Oncol.,
May 15, 2001;
19(10):
2647 - 2657.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Fadel, B. Court, A. R. Chapelier, J. P. Droz, and P. Dartevelle
One-stage approach for retroperitoneal and mediastinal metastatic testicular tumor resection
Ann. Thorac. Surg.,
June 1, 2000;
69(6):
1717 - 1721.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. W. Steyerberg, H. J. Keizer, D. T. Sleijfer, S. D. Fosså, D. F. Bajorin, A. Gerl, R. de Wit, W. J. Kirkels, H. S. Koops, and J. D. F. Habbema
Retroperitoneal Metastases in Testicular Cancer: Role of CT Measurements of Residual Masses in Decision Making for Resection after Chemotherapy
Radiology,
May 1, 2000;
215(2):
437 - 444.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
G. J. Bosl and R. J. Motzer
Testicular Germ-Cell Cancer
N. Engl. J. Med.,
July 24, 1997;
337(4):
242 - 254.
[Full Text]
[PDF]
|
|
|
|
