Residual Tumor Resection After High-Dose Chemotherapy in Patients With Relapsed or Refractory Germ Cell Cancer

Rick, Oliver; Bokemeyer, Carsten; Weinknecht, S.; Schirren, J.; Pottek, Tobias; Hartmann, Jörg T.; Braun, T; Rachud, B; Weißbach, L.; Hartmann, Michael; Siegert, W.; Beyer, Jörg

doi:10.1200/jco.2004.07.124

Cited by 90 publications

(37 citation statements)

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“…10 The histologic findings after multiple chemotherapy regimens differ substantially from those generally reported for RPLND after induction chemotherapy, in which approximately 40% to 45% of patients have fibrosis, 40% to 45% of patients have teratoma, and 10% to 20% have viable GCT. 11,12 For RPLND after multiple chemotherapy regimens, the largest series of patients, which was reported in 1993 by Fox et al, 5 had 55% with viable GCT, consistent with 2 subsequent studies by Hendry et al 6 and Rick et al, 7 which showed rates of 42% and 49%, respectively. In the current study, there were 4 important findings for patients undergoing RPLND after multiple chemotherapy regimens.…”

Section: Discussionsupporting

confidence: 67%

“…When RPLND is performed in this setting, it has been reported that viable GCT occurs in approximately 50% of patients. [5][6][7] Because of the high proportion of men with viable GCT or teratoma after salvage chemotherapy, surgical resection of all disease sites is attempted when feasible. The objectives of the current study were to review the Memorial Sloan-Kettering Cancer Center experience with RPLND after multiple chemotherapy regimens and specifically evaluate the clinicopathologic and treatment trends in addition to potential predictors of disease-specific outcome.…”

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confidence: 99%

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Pathologic findings and clinical outcome of patients undergoing retroperitoneal lymph node dissection after multiple chemotherapy regimens for metastatic testicular germ cell tumors

Eggener¹,

Carver²,

Loeb³

et al. 2006

Cancer

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BACKGROUND.Postchemotherapy surgery is an essential component in the management of patients with metastatic germ cell tumors (GCT). The authors assessed their institutional experience of retroperitoneal lymph node dissection (RPLND) after multiple chemotherapy regimens for advanced GCT.METHODS.By analyzing the institutional prospective surgical database from 1989 to 2004, 71 patients were identified who underwent RPLND after multiple chemotherapy regimens. Clinicopathologic and treatment trends were characterized, and predictors of disease‐specific survival (DSS) were evaluated.RESULTS.The histologic findings at RPLND were fibrosis in 36 men (51%), GCT in 20 men (28%), and teratoma in 15 men (21%). Patients who underwent RPLND from 1989 to 1998 (n = 47), compared with patients who underwent RPLND from 1999 to 2004 (n = 24) were more likely to have GCT (36% vs 13%; P = .04). Patients who received taxane‐containing chemotherapy regimens as salvage therapy had lower rates of GCT at RPLND (14% vs 42%; P = .01), higher rates of fibrosis (63% vs 39%; P = .04), and similar rates of teratoma (31% vs 33%; P = .9). The 5‐ and 10‐year DSS rates were 74% (95% confidence interval [95% CI], 62–86%) and 70% (95% CI, 56–84%), respectively. Five‐year DSS based on worst histology of RPLND and extraretroperitoneal specimens was 87% (95% CI, 75–99%) for fibrosis, 87% for teratoma (95% CI, 63–100%), and 47% for GCT (95% CI, 23–71%; P = .004). On multivariable analysis, retroperitoneal mass ≥5 cm and GCT were predictors of worse DSS (P = .03 and P = .005, respectively).CONCLUSIONS.Taxane‐based salvage chemotherapeutic regimens appear to have decreased the rate of GCT at RPLND. The current data support RPLND in select patients after salvage chemotherapy, because a considerable proportion has teratoma or GCT, and the 10‐year DSS rate after resection is 70%. Cancer 2007;109:528–535. © 2006 American Cancer Society.

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Section: Discussionsupporting

confidence: 67%

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confidence: 99%

Pathologic findings and clinical outcome of patients undergoing retroperitoneal lymph node dissection after multiple chemotherapy regimens for metastatic testicular germ cell tumors

Eggener¹,

Carver²,

Loeb³

et al. 2006

Cancer

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“…In retrospective series, the reported proportion of patients with viable cancer in resected masses who suffered a relapse and underwent salvage chemotherapy was as high as 70% [30,31,32,33,34]. …”

Section: Resultsmentioning

confidence: 99%

The Role of Salvage High-Dose Chemotherapy in Relapsed Male Germ Cell Tumors

Oing

Lorch

2018

Oncol Res Treat

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Germ cell tumors (GCT) are a unique tumor entity with excellent cure rates if guideline-endorsed treatment is thoroughly applied. Even patients with widespread metastatic disease can often be cured with cisplatin-based combination chemotherapy as part of a multimodal treatment approach. However, about 30% of patients with metastatic disease at initial presentation, corresponding to about 5-10% of all GCT patients, relapse or progress despite first-line treatment and therefore require salvage chemotherapy. Salvage systemic treatment either consists of conventional-dose cisplatin-based combination chemotherapy or sequential high-dose treatment with carboplatin and etoposide plus subsequent autologous stem cell support. This review is based on a comprehensive literature search of MEDLINE and conference proceedings of ESMO, ASCO, and EAU meetings until 2018 and provides an overview of current treatment options for germ cell cancer patients relapsing after or progressing during first-line cisplatin-based combination chemotherapy.

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“…When rPLa is performed in this setting, it has been reported that VC occurs in approximately 50% of patients 5,6,7 . Because of the high proportion of men with VC or teratoma after salvage chemotherapy, surgical resection of all disease sites is attempted when feasible.…”

Section: Introductionmentioning

confidence: 99%

Pathologic findings and clinical outcome in patients undergoing retroperitoneal lymphadenectomy after multiple chemorherapy regimens for metastatic nonseminomatous testicular tumors

Argirovic¹,

Argirović²

2011

Mat Med

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We reviewed our experience with retroperitoneal lymphadenectomy (rPLa) after multiple cisplatin-based chemotherapy regimens in nonseminomatous testicular tumors (NsTT) patients and specifically evaluated clinicopathologic and treatment trend in addition to potential predictors of survival. Fort-one patients with NsTT underwent their rPLa between 1982 and 2005 after ≥ 2 regimens of chemotherapy. Thirteen patients (32%) necessitate redo-rPLa, combined with nephrectomy in 6 patients. 13 extra-rP (ErP) resections were performed in 11 patients (27%), including pulmonary (7), neck (4) and liver (2) sites. Thirty patients (73%) are rendered free of disease and 26 (63%) obtained serologic remission. Nine patients who relapse, necessitated new salvage chemotherapy+surgery (3 teratoma, 6 vital carcinoma [VC]). Four of 9 relapsing patients (44%) are currently free of disease with redorPLa. alive, free of disease are 19 pts (46%) at median follow-up of 131 months. study of rP pathology demonstrated the presence of fibrosis in 15%, teratoma in 39% and VC in 46%, with survival in 67%, 56% and 32%, respectively. different histology occurred in 38% at redo-rPLa and in 64% at ErP resection in comparison to previous rP pathology. Univariate analysis of clinicopathologic parameters associated with VC at rPLa included rP masses ≥ 5 cm (p<0.05), elevated aFP (p<0.001) or HCG (p<0.05) and ErP resection (p<0.04). On univariate analysis survival was worse in patients with rP masses ≥ 5 cm (p<0.04), elevated aFP (p<0.05) or HCG (p<0.007), ErP resection (p<0.01) and VC (p<0.004). On multivariable analysis, a rP masses ≥ 5 cm (p<0.03) and VC (p<0.005) predicted a worse ApstraktNapravljen je pregled iskustva sa retroperitonealnom limfadenektomija (rPLa), a posle brojnih hemioterapijskih ciklusa na bazi cisplatine kod pacijenata sa neseminomskim tumorima testis (NsTT) i posebno evaluirani kliničko patološki i terapeutski trendovi kao dodatak potencijalnim pokazateljima preživljava-nja. 41 pacijent sa NsTT su podvrgnuti rPLa izmedju 1982.-2005. posle ≥ 2 hemioterapijskih protokola. 13 pacijenata ( 32% ) je iziskivalo ponovnu rPLa, kombinovanu sa nefrektomijom kod 6 pacijenata. 13 ekstraretroperitonealnih resekcija je učinjeno kod 11 pacijenata (27%) uključujući pulmonalne (7), vratne (4) i jetrine (2) lokalizacije. 30 pacijenata (73%) je prevedeno u kompletnu remisiju dok je 26 (63%) imalo serološku remisiju. 9 pacijenata (32%) je imalo recidiv iziskujući novu selvage hemioterapiju i hirurgij (3 teratoma, 6 vitalni karcinom). 4 od 9 pacijenata (44%) sa recidivom je bilo bez znakova bolesti posle ponovne rPLa. živo i bez znakova bolesti je 19 pacijenata (46%) za srednje praćenje od 131 meseca. retroperitonealna histološka analiza je pokazala prisustvo fibroze kod 15%, teratoma kod 39% I vitalnog karcinom kod 46%, sa preživljavanjem kod 67%, 56%, 32% respektivno. različita histopatologija je postojala kod 38% na ponovnoj rPLa i kod 64% na ekstraretroperitonealnoj resekciji u odnosu na raniju retroperitonealnu histologiju. Nivarijantna...

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Residual Tumor Resection After High-Dose Chemotherapy in Patients With Relapsed or Refractory Germ Cell Cancer

Abstract: Resections of all residual tumors should be attempted in patients with relapsed or refractory GCT and partial remissions after HDCT.

Cited by 90 publications

References 19 publications

Pathologic findings and clinical outcome of patients undergoing retroperitoneal lymph node dissection after multiple chemotherapy regimens for metastatic testicular germ cell tumors

Pathologic findings and clinical outcome of patients undergoing retroperitoneal lymph node dissection after multiple chemotherapy regimens for metastatic testicular germ cell tumors

The Role of Salvage High-Dose Chemotherapy in Relapsed Male Germ Cell Tumors

Pathologic findings and clinical outcome in patients undergoing retroperitoneal lymphadenectomy after multiple chemorherapy regimens for metastatic nonseminomatous testicular tumors

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