The management of residual masses after chemotherapy in metastatic seminoma

Objective To review our experience in management of residual masses after c hemotherapy for metastatic seminoma. Patients and methods The study comprised a review of 107 patients with meta static seminoma, treated with initial chemotherapy from 1978 to 1996, Forty -three patients had residual masses detected by computed tomography after c hemotherapy, while 64 achieved a complete response. Residual masses were cl assified radiologically as <3 cm or greater than or equal to 3 cm and as we ll- or poorly defined. Of the patients with residual masses, 19 underwent s urgery, while 24 were observed. Results Viable cancer was present in six of 11 patients with well-defined r esidual masses of greater than or equal to 3 cm (positive histology in thre e of six undergoing surgery and site relapses in three of five observed), o ne of 14 patients with poorly defined masses of greater than or equal to 3 cm (negative histology in nine undergoing surgery and site relapse in one o f five observed), and in none of 17 patients with residual masses of <3 cm (negative histology in four undergoing surgery and no site relapses in 13 o bserved; one additional patient in this group died from treatment complicat ions). Conclusion Patients with a complete response after chemotherapy, a residual mass of <3 cm and a poorly defined residual mass of greater than or equal to 3 cm can be observed, reserving intervention for recurrent or progressiv e disease. Well-defined residual masses of greater than or equal to 3 cm sh ould be resected because there is a 55% likelihood of persistent tumour.