Metastatic nonseminomatous germ cell tumors of the testis

Hendry, W. F.; Norman, A.; Dearnaley, David P.; Fisher, Cyril; Nicholls, J.; Huddart, Robert; Horwich, A.

doi:10.1002/cncr.10440

Cited by 139 publications

(20 citation statements)

References 136 publications

(119 reference statements)

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“…Resection of residual tumor after complete serological remission due to first and/or second line chemotherapy in patients with metastatic germ cell tumors is an established staging and therapeutic procedure[9]. However, it is important to continuously evaluate the rates of surgical complications, the presence of residual cancer post-chemotherapy and clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal lymph node dissection for residual masses after chemotherapyin nonseminomatous germ cell testicular tumor

et al. 2010

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BackgroundRetroperitoneal lymph node dissection has been advocated for the management of post-chemotherapy (PC-RPLND) residual masses of non-seminomatous germ cell tumors of the testis (NSGCT). There remains some debate as to the clinical benefit and associated morbidity. Our objective was to report our experience with PC-RPLND in NSGCT.MethodsWe have reviewed the clinical, pathologic and surgical parameters associated with PC-RPLND in a single institution. Between 1994 and 2008, three surgeons operated 73 patients with residual masses after cisplatin-based chemotherapy for a metastatic testicular cancer. Patients needed to have normal postchemotherapy serum tumor markers, no prior surgical attempts to resect retroperitoneal masses and resectable retroperitoneal tumor mass at surgery to be included in this analysisResultsMean age was 30.4 years old. Fifty-three percent had mixed germ cell tumors. The mean size of retroperitoneal metastasis was 6.3 and 4.0 cm, before and post-chemotherapy, respectively. In 56% of patients, the surgeon was able to perform a nerve sparing procedure. The overall complication rate was 27.4% and no patient died due to surgical complications. The pathologic review showed presence of fibrosis/necrosis, teratoma and viable tumor (non-teratoma) in 27 (37.0%), 30 (41.1%) and 16 (21.9%) patients, respectively. The subgroups presenting fibrosis and large tumors were more likely to have a surgical complication and had less nerve sparing procedures.ConclusionPC-RPLND is a relatively safe procedure. The presence of fibrosis and large residual masses are associated with surgical complications and non-nerve-sparing procedure.

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Section: Discussionmentioning

confidence: 99%

Retroperitoneal lymph node dissection for residual masses after chemotherapyin nonseminomatous germ cell testicular tumor

et al. 2010

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“…Once the mass is detected, the timing of the RPLND should be prompt and the resection complete. Hendry et al ,[10] demonstrated a significant benefit (83% vs. 62%) in progression free survival and in cancer specific survival (89% vs. 56%) in those men undergoing immediate surgery. In a contemporary study,[11] it was shown that half of the men with local recurrence after post chemotherapy RPLND had been incompletely resected at the time of the primary surgery.…”

Section: Post-chemotherapy Rplndmentioning

confidence: 99%

Management of post-chemotherapy residual mass in patients with metastatic nonseminomatous germ cell tumors of the testis

Fitzgerald¹,

Ercole²,

Parekh³

2010

Indian J Urol

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The basis of treatment for advanced germ cell tumors is chemotherapy and surgical resection of residual disease. Surgery has maintained its role in staging and therapeutic management. Despite these advances, much of the outcomes depend on proper patient selection. Complete removal of all post-chemotherapy residual masses remains the standard of care in the treatment of advanced nonseminomatous germ cell tumors both within and outside of the retroperitoneum.

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“…For example, meta-analysis for variable factors and two similar cohorts from the United States and Europe have been used for model development and validation. [112] Therefore, we aimed to identify the predictors of viable GCT in postchemotherapeutic residual retroperitoneal masses.…”

Section: Introductionmentioning

confidence: 99%

Predictors of viable germ cell tumor in postchemotherapeutic residual retroperitoneal masses

Othman¹,

Hathal²,

Mokhtar³

2014

Urol Ann

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Objective:The aim of this study was to identify predictors of viable germ cell tumor (GCT) in postchemotherapeutic residual retroperitoneal masses.Materials and Methods:The pertinent clinical and pathologic data of 16 male patients who underwent postchemotherapeutic retroperitoneal lymph node dissection (PC-RPLND) at King Faisal Specialist Hospital and Research Centre between 1994 and 2005 were reviewed retrospectively. It was found that all patients received cisplatin-based chemotherapy for advanced testicular GCT.Results:Out of the 16 male patients, 2 (13%), 8 (50%), and 6 (37%) had viable GCT, fibrosis, and teratoma, respectively. Ten (10) of the patients with prechemotherapeutic S1 tumor markers did not have viable GCT, and two of the six patients who had prechemotherapeutic S2 tumor markers have viable GCT. All tumor marker levels normalized after chemotherapy even in patients with viable GCT. Four patients had vascular invasion without viable GCT. Furthermore, four patients had more than 60% embryonal elements in the original pathology, but only 1 had viable GCT at PC-RPLND. Four of the five patients with immature teratoma had teratoma at PC-RPLND but no viable GCT; however, out of the four patients with mature teratoma, one had viable GCT and two had teratoma at PC-RPLND. Of the two patients with viable GCT, one had 100% embryonal cancer in the original pathology, prechemotherapeutic S2 tumor markers, history of orchiopexy, and no vascular invasion; the other patient had yolk sac tumor with 25% embryonal elements and 40% teratoma in the original pathology, and prechemotherapeutic S2 tumor markers.Conclusion:None of the clinical or pathological parameters showed a strong correlation with the presence of viable GCT in PC-RPLND. However, patients with ≥S2 may be at higher risk to have viable GCT. Further studies are needed to clarify this.

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Metastatic nonseminomatous germ cell tumors of the testis

Cited by 139 publications

References 136 publications

Retroperitoneal lymph node dissection for residual masses after chemotherapyin nonseminomatous germ cell testicular tumor

Retroperitoneal lymph node dissection for residual masses after chemotherapyin nonseminomatous germ cell testicular tumor

Management of post-chemotherapy residual mass in patients with metastatic nonseminomatous germ cell tumors of the testis

Predictors of viable germ cell tumor in postchemotherapeutic residual retroperitoneal masses

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