MATURE TERATOMA IDENTIFIED AFTER POSTCHEMOTHERAPY SURGERY IN PATIENTSWITH DISSEMINATED NONSEMINOMATOUS TESTICULAR GERM-CELL TUMORS - A PLEA FOR AN AGGRESSIVE SURGICAL APPROACH

BACKGROUND. Mature teratoma is often found in resected retroperitoneal residual tumor masses (RRTM) after chemotherapy for disseminated nons eminomatous testicular germ cell tumors (NSTGCT). The aim of this repo rt is to describe the clinical course of patients after resection of r esidual teratoma, with particular emphasis on relapse with either grow ing mature teratoma or secondary non-germ cell malignancy. METHODS, Du ring the period 1979-1995, 113 patients underwent a laparotomy for res ection of RRTM after chemotherapy for NSTGCT. Only patients with matur e teratoma in the RRTM were included in the current study, and data on the patients who experienced relapse were studied in detail. RESULTS, Mature teratoma was found in 51 patients (45.1%) with RRTM resected a fter chemotherapy. Nine of these 51 patients (17.6%) relapsed; the rel apses resulted from growing mature teratoma in 5 patients (9.8%), seco ndary non-germ cell malignancy in 3 patients (5.9%), and recurrent ger m cell malignancy in 1 patient (2.0%). The primary treatment for all r elapsing patients was surgical excision. AU five patients with growing mature teratoma are alive without evidence of disease, as is the pati ent with recurrent germ cell malignancy. One of the three patients wit h non-germ cell malignancy died of disease, and the remaining two are alive with disease. CONCLUSIONS, Long term follow-up after resection o f postchemotherapy residual teratoma is indicated because a proportion of patients develop growing mature teratoma or a secondary non-germ c ell malignancy. The treatment for these recurrences should be complete surgical excision. (C) 1998 American Cancer Society.