A CASE OF EXTRAGONADAL GERM-CELL TUMOR WITH ELEVATED POSTCHEMOTHERAPYHCG SUCCESSFULLY TREATED BY RESECTION OF A SOLITARY METASTASIS AND CHRONIC ORAL ETOPOSIDE

We report a 39-year-old man with disseminated extragonadal germ cell t umor (GCT), whose se rum level of human chorionic gonadotropin (HCG) i ncreased again after platinum-based combination chemotherapy, high-dos e chemotherapy with autologous bone marrow rescue and radical adjuncti ve surgery. The increase in the HCG level was progressive in spite of multiple chemotherapy, and after a while, a coin lesion in the right l ung was identified by chest roentgenography. The plumonary lesion was refractory to additional chemotherapy. After a systemic survey to conf irm that the lesion was solitary, video-assisted thoracoscopic wedge r esection of the right lower lobe was performed. Because the resected t umor included viable tumor cells and the serum HCG level remained slig htly high one month after the operation, oral low-dose etoposide was b egun. In a short time, the level of the serum tumor marker decreased a nd remained normal during the subsequent 7 months of therapy and there after. The patient remains in complete remission 13 months after compl etion of the final therapy and 3 years after the initial diagnosis. Ev en if the level of a serum tumor marker is high, salvage resection can be a promising therapeutic option for operable tumors that are refrac tory to chemotherapy. The usefulness of chronic oral etoposide for pat ients with GCT should be examined by further clinical trials.