Management of Post-Chemotherapy Residual Masses in Advanced Seminoma

Abstract

In our study there was incomplete surgical resection in 30% of cases. Relapse in 16.6% of cases occurred rapidly after the end of chemotherapy. Viable cells were only noted in residual masses 3 cm. or greater (13%) and 50% of residual masses disappeared during surveillance. We intend to perform a prospective cohort study with close followup of patients with residual masses less than 3 cm. using an indication for surgery tailored to positron emission tomography findings in those with residual masses 3 cm. or greater.

Can We Rely on PET in the Follow-Up of Advanced Seminoma Patients?

“…A cutoff of >3 cm lesion size is commonly used, with some authors suggesting resection of all residual lesions >3 cm [3,4,8,19,20]. This strategy, however, results in overtreatment of nearly 60% of patients, as viable cancer cells are reported to be found only in 30–50% (37.5% in our study) of residuals >3 cm [4,5,7,21,22,23]. Still, De Santis et al [15] consider, based on their results and review of other studies, surgery to be the treatment of choice for residuals with a high risk of relapse, with more favorable results than surveillance.…”

“…Approximately 25% of patients present with advanced stage disease [1]. After chemotherapy, radiologically detectable residual masses are found in about 60% of them [2,3,4,5] and relapses occur in 10–15% of these patients [6]. …”

Beurteilung von Residualtumoren nach Systemtherapie des metastasierten Seminoms

“…Residuen >3 cm haben hierbei ein Risiko von ca. 30%, vitales Tumorgewebe zu enthalten [8,13,22,23]. Die operative Therapie dieser Läsionen beinhaltet jedoch ein hohes Risiko bzgl.…”

“…80% der behandelten Patienten; diese können unmittelbar nach Beendigung der Chemotherapie diagnostiziert werden [8,12]. Läsionen >3 cm enthalten entsprechend der Literatur noch in etwa 30% der Fälle vitales Tumorgewebe, weshalb nach Empfehlung des "Sloan-Kettering Cancer Centers" eine Biopsie bzw.…”

Testis cancer

“…If <3 cm then surveillance alone is adequate; if ⩾3 cm then management is not as simple, with some recommending surgical resection 26. There is little evidence supporting adjuvant treatment after combination chemotherapy for advanced seminomas and some of these masses show fibrosis alone 27.…”