SIZE AND STATUS OF METASTASES AFTER INDUCTIVE CHEMOTHERAPY OF GERM-CELL TURNERS - INDICATION FOR SALVAGE OPERATION

Secondary resection of metastases remaining after inductive chemothera py of advanced germ-cell tumors has thus far been obligatory. The abse nce of malignant components in one-third of all residual tumors and th e high risk of the operation have led several authors to reconsider th e criteria for this approach. In a retrospective study of 153 cases (1 27 evaluable) we investigated the histology of the primary tumor and t he size of the residual tumor with regard to residual histology and ou tcome. Patients were divided into the following three groups according to the histology of the primary tumor: group I, pure seminoma (16 pat ients); group II, nonseminoma without teratoma (32 patients); and grou p III, nonseminoma with teratoma (79 patients). Among the 16 purely se minomatous tumors, the residual masses ranged from 2 to 12 cm; 12 cons isted of necrotic tissue only, 3 contained malignant germ-cell element s, and 1 contained adult teratoma. The residuals of primarily teratoma -free nonseminomas measured 2-16 cm; the smallest residual tumor conta ining active malignant elements measured 4 cm, and the diameter of the largest necrotic residue was 6 cm. Four residuals contained mature te ratoma. The size of residuals from teratomatous primary tumors was 3-2 4 cm; the smallest malignant tumor measured 5 cm, and the diamter of t he largest purely necrotic mass was 8 cm. According to our results, a secondary operation may be omitted if the residual mass of a primary s eminoma is smaller than 5 cm or if that of a primary nonseminoma witho ut teratoma is less than 3 cm in diameter. However, firm conclusions c an be drawn only after these criteria have been confirmed by an ongoin g multicenter trial.