SURGERY AS SALVAGE THERAPY IN CHEMOTHERAPY-RESISTANT NONSEMINOMATOUS GERM-CELL TUMORS

Objective To review our experience of surgical staging for residual ma sses after chemotherapy in patients with nonseminomatous germ cell tum our (NSGCT) and positive tumour markers. Patients and methods Of 107 p atients with metastatic NSGCTs treated surgically after chemotherapy f rom 1978 to 1995, 30 (median age 30.5 years, range 20-52) had positive tumour markers. These patients were reviewed and the outcome compared with 77 patients who had normal tumour marker values. Results Of the 77 patients with negative markers undergoing surgical/pathological sta ging, 71 (92%) became continuously disease-free, including 37 of 50 (7 4%) with viable NSGCT in excised specimens. Seventeen of 30 (57%) with raised marker levels undergoing similar surgery for chemotherapy-resi stant: tumour became disease-free, including 11 of 22 with viable NSGC T in the excised specimens, Conclusion Although the outcome after surg ery is better in patients with negative tumour markers, it is clear th at surgery is curative for patients with localized chemotherapy-resist ant masses. There is a need for continued debate on the timing of salv age surgery and subsequent chemotherapy.