R. Ravi et al., SURGERY AS SALVAGE THERAPY IN CHEMOTHERAPY-RESISTANT NONSEMINOMATOUS GERM-CELL TUMORS, British Journal of Urology, 81(6), 1998, pp. 884-888
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.