Long-term follow-up of residual masses after chemotherapy in patients with non-seminomatous germ cell tumours

Abstract

Summary This retrospective study was undertaken to determine the outcome of patients with non-seminomatous germ cell tumour who achieved a serological complete response but who had residual radiologic abnormalities upon completion of primary platinum-based chemotherapy. This was an analysis of 76 consecutive patients treated at Mount Vernon Hospital between 1983 and 1997. The patients were placed into two groups based upon whether they had surgical resection (surgery group, 48 patients) or observation (observation group, 28 patients) of residual radiologic masses on completion of initial chemotherapy (to enter the surgery group, complete surgical resection must have been achieved). The primary end-points were progression-free and overall survival. The percentage of patients alive with median followup 66 months was 90% for the surgery group and 80% for the observation group (P = 0.53, not significant). The percentage of patients continuously disease-free was 70% in the surgery group and 80% in the observation group (P = 0.31, not significant). In the small sub-group of patients with differentiated teratoma (TD) in the primary lesion who were observed, there was no excess risk of relapse or death. Patients who achieve a serological complete response after primary chemotherapy, but are left with ≤ 2 cm radiological masses that are not cystic and have responded, can be safely observed with diligent follow-up.

Oncological outcomes in non-seminomatous testicular tumors and residual mass after cisplatin-based chemotherapy

“…They included 76 patients of whom 48 had surgery and 28 patients were observed. Above 90% and 80% of patients were alive, and 70% and 80% were disease-free after surgery and observation, respectively, these findings were not statistically significant (p = 0.05 and p = 0.3, respectively) 12 . In our cohort, patients who were observed had an increased risk of progression compared to patients having RPL (p = 0.01) as well as shorter OS in patients observed compared to surgical intervention (p = 0.01).…”

“…On the other hand, teratoma is known to be chemoresistant and has the potential for malignant transformation and RPLND is curative in this setting 10,11 . There have been described important survival factors in patients with viable tumors 5,12,13 , and recommended to remove all residual lesions larger than 1 cm in patients with NSGCT [14][15][16] .…”

“…There is scarce data of the usefulness of the PET/CT FDG in NSGCT with inconclusive results 12,[17][18][19] , Oechsle et al conducted a multicenter study, where they found PET can predict viable tumors in 56% of cases, and has an overall sensitivity and specificity of 70% and 48, respectively 14 . In our study, 80% of PET's were positive with teratoma being the most common finding.…”

Use of fluorodeoxyglucose positron emission tomography scans in patients with advanced germ cell tumour following chemotherapy: single‐centre experience with long‐term follow up*

“…Retroperit­oneal lymph node resection in all non‐seminomatous germ cell tumour (NSGCT) patients that present with masses that are initially>3 cm has been advocated by investigators from the Memorial Sloan Kettering Cancer Centre 5 . Other investigators have supported a policy of observation when the prognostic factors are favourable 6−9 . These prognostic factors include: (i) the size of the residual mass, (ii) the degree of reduction in size of the mass following chemotherapy and (iii) the original tumour histology 10 .…”

“…5 Other investigators have supported a policy of observation when the prognostic factors are favourable. [6][7][8][9] These prognostic factors include: (i) the size of the residual mass, (ii) the degree of reduction in size of Internal Medicine Journal 2003; 33: 427-435 the mass following chemotherapy and (iii) the original tumour histology. 10 Seminomatous residual masses are usually more difficult to completely resect and are more likely to comprise of necrotic/fibrotic tissue only.…”