RESULTS OF POSTCHEMOTHERAPY ADJUNCTIVE RETROPERITONEAL LYMPH-NODE DISSECTION IN NONSEMINOMATOUS GERM-CELL CANCER-PATIENTS

Cisplatin-based chemotherapy is highly effective in non-seminomatous t esticular cancer. Patients with advanced disease receive two to four c ycles of polychemotherapy. Residual retroperitoneal masses after chemo therapy are suspected to contain active tumour tissue as well as matur e teratoma. Therefore, a delayed retroperitoneal lymph node dissection remains necessary. A total of 123 patients with advanced non-seminoma tous germ cell cancer underwent retroperitoneal surgery after two diff erent regimes of cisplatin-based chemotherapy. The first group (n = 55 ) received a sequential alternating chemotherapy with Adriamycin/cispl atin and bleomycin/vinblastine (8.5 +/- 5 cycles, 1979-1985), the seco nd group (n = 60) got a standard FEB scheme (cisplatinum/etoposide/ble omycin; 5.7 +/- 2.1 cycles, 1985-1991). Eight patients got other cispl atin-based combinations. All patients received adjunctive retroperiton eal surgery. After a mean follow-up period of 72 months, the patients treated with the sequential alternating scheme showed a survival rate of 50% (27/54, 1 patient lost to follow-up). After the FEB scheme a su rvival rate of 79% (46/58, 2 patients lost to follow-up) was found. 86 % of the patients with retroperitoneal necrosis after retroperitoneal lymph node dissection (RPLND; n = 58) survived with no evidence of dis ease, as well as 82% of the patients with adult teratoma (n = 18). Onl y 47% of the patients with residual active carcinoma after RPLND (n = 47) survived within a follow-up period of(median) 72 months, despite f urther chemotherapy after RPLND. Residual tumor burden and type of his tology after RPLND can partially predict the clinical outcome. A necro tic specimen in RPLND could not be predicted by any means, so that sur gical removal of a residual retroperitoneal mass after chemotherapy re mains necessary. Standard FEB chemotherapy is superior to sequential a lternating chemotherapy.