Results of salvage retroperitoneal lymphadenectomy (RLA) in the treatment of patients with nonseminomatous germ cell tumours remaining marker positive after inductive chemotherapy

Abstract

The authors describe the evidence and results obtained in 21 out of 100 patients who underwent salvage retroperitoneal lymphadenectomy for advanced testicular cancer (UICC stage II/B bulky and stage III) in the period 1982-1993, and in whom inductive chemotherapy was not followed by marker conversion. It is stated that if AFP positivity is low (titres below 100 ng/ml) salvage retroperitoneal lymphadenectomy (RLA) is of high therapeutic value, whereas in all cases with HCG positivity or AFP titres higher than 500 ng/ml tumorous death ensued without exception. In our cases viable tumour residues occurred in 81%. Salvage resection was feasible in 76%, but every incomplete resection (19%) was followed by death due to tumour. In all but one of the cases marker positivity, an indicator of therapy-resistant viable tumour residues, persisted after having used more than four PVB combinations or changes in the chemotherapeutic regimen.

Retroperitoneal lymph node dissection after chemotherapy in patients with elevated tumour markers: indications, histopathology and outcome

“…[11], all five patients with raised hCG levels relapsed after their surgery, compared to only three of 10 with only elevated α‐fetoprotein levels. Other reported series [4,8,9] showed similar findings, with elevation of hCG being identified as an adverse prognostic factor. In these patients with elevations of hCG alone, surgery rarely appears to be adequate to achieve long‐term favourable results, and close collaboration with the oncology team is essential in managing these patients.…”

“…Our results from 48 patients with elevated tumour markers undergoing pcRPLND forms one of the largest series published, and confirms several findings in previous reports. In the present series the overall 5‐year survival was 69%, which compares to other published studies which had overall survival rates of 37–73%[6–12].…”

“…Generally surgery is not routinely part of the standard practice for these patients with elevated markers, but several reports suggest that retroperitoneal lymph node dissection after chemotherapy (pcRPLND) in the presence of elevated tumour markers, often termed ‘desperation RPLND’, can have a significant role in successful management [4–11]. The data from these case series of ‘desperation’ pcRPLNDs report long‐term survival rates of 33–75%[12].…”

Interdisziplinärer Konsensus zur Diagnostik und Therapie von Hodentumoren Ergebnisse einer Update-Konferenz auf Grundlage evidenzbasierter Medizin (EBM)

“…25% längerfristiges Überleben belegt) (EBM III: [116,214,216,222,224,[232][233][234][235][236][237][238][239][240][241]). Bei Markeranstieg und fehlenden weiteren chemotherapeutischen Optionen ist ebenfalls bei kompletter Resektabilität der Tumormanifestation eine Resektion anzustreben (in ca.…”

A Review of Second-line Chemotherapy and Prognostic Models for Disseminated Germ Cell Tumors

“…A small proportion of patients with relapsed disease that is locally confined may achieve durable remissions with surgical resection alone. 8–10 …”