POSTCHEMOTHERAPY RETROPERITONEAL LYMPH-NODE DISSECTION IS EFFECTIVE THERAPY IN SELECTED PATIENTS WITH ELEVATED TUMOR-MARKERS AFTER PRIMARY CHEMOTHERAPY ALONE

Objectives. Elevated tumor markers after primary chemotherapy for meta static testis cancer are usually an indication of persistent cancer. S ubsequent treatment has usually been salvage chemotherapy. This articl e examines the possibility that selected patients can achieve long-ter m disease-free survival with surgery alone. Methods. Using a computeri zed data base of 627 postinduction chemotherapy retroperitoneal lymph node dissections (PC-RPLND), 23 patients with elevated tumor markers w ho have undergone PC-RPLND after induction chemotherapy alone were ide ntified. Of the 23 patients, 15 were considered candidates for salvage chemotherapy, but instead underwent salvage surgery. Case histories w ere reviewed to establish selection criteria for PC-RPLND. Results. Ei ght patients originally presented as clinical Stage C, 6 as clinical S tage B-3, and 1 as clinical Stage B-2. All patients initially received cisplatin combination chemotherapy. Twelve patients had an elevated a lpha-fetoprotein level and 3 patients had an elevated beta human chori onic gonadotropin level prior to PC-RPLND. Seven patients had rising m arkers at the time of PC-RPLND. Seven patients had teratoma only in th eir resected specimen and all have no evidence of disease (NED) at a m edian of 35 months. Two patients had necrosis only in their RPLND spec imen and both are NED at 10 and 42 months. Six patients had cancer in their resected specimen and 2 are NED, 1 is alive with disease, and 3 are dead of disease. Five of the 6 patients with cancer in their resec ted specimen were the only patients who received postoperative chemoth erapy. Conclusions. Some patients with modest elevations of tumor mark ers after induction chemotherapy may only have teratoma or necrosis in the postchemotherapy resected specimen. These patients (n = 9) remain continuously NED. Patients who undergo salvage surgery and have cance r in the resected specimen do less well, but selected patients can be cured with this modality and thus avoid the morbidity of salvage chemo therapy. (C) 1997, Elsevier Science Inc. All rights reserved.