SURGICAL RESECTION IN PATIENTS WITH NONSEMINOMATOUS GERM-CELL TUMOR WHO FAIL TO NORMALIZE SERUM TUMOR-MARKERS AFTER CHEMOTHERAPY

Objective. Patients with high-stage nonseminomatous germ cell tumors t reated with platinum-based chemotherapy who have residual radiographic evidence of disease and fail to normalize tumor markers present a dif ficult clinical dilemma. Some authors feel that these patients are not appropriate surgical candidates. Our practice has been to offer certa in patients salvage surgery in an attempt for cure, this report is des igned to review that experience and critically analyze the results. Me thod. We report a series of 16 such patients with advanced-stage nonse minomatous germ tell tumors who had persistently elevated alpha fetopr otein and/or human chorionic gonadotropin. All underwent resection of all radiographically evident sites of residual disease following induc tion or salvage chemotherapy. Results. Ten patients had only retroperi toneal (RP) metastasis. Six patients had more than one site of residua l disease-4 RP and lung, 2 RP and liver. There were no postoperative d eaths. The mean postoperative stay was eleven days (range 7 to 36 days ). Six patients (37%) are alive and free of disease at a mean of seven ty-four months following surgery (range 20 to 145 months). Five had RP disease only. Ten patients died of disease at a mean of eight months postoperatively (range 5 to 21 months). Conclusions. Patients with adv anced nonseminomatous germ cell tumor who fail to normalize their seru m tumor markers after adequate platinum-based chemotherapy should be c onsidered for surgical resection of all radiographically evident resid ual disease. In select cases this practice offers the only viable chan ce for cure.