COMPARISON OF HISTOLOGICAL RESULTS FROM THE RESECTION OF RESIDUAL MASSES AT DIFFERENT SITES AFTER CHEMOTHERAPY FOR METASTATIC NONSEMINOMATOUS GERM-CELL TUMORS

Cisplatin-based combination chemotherapy is considered standard treatm ent for patients with metastatic testicular cancer. However, despite t he normalisation of serum tumour markers, 25-50% of patients will demo nstrate residual neoplastic masses on radiological examination after c ompletion of chemotherapy. The management of patients presenting with multiple residual masses at different localisations remains particular ly difficult. This report summarises the histological findings and the clinical outcome of 27 patients with metastatic non-seminomatous germ cell tumours who underwent multiple resections for residual masses at different localisations after first-line cisplatin-based chemotherapy at Hannover University Medical School between 1980 and 1995. Fifty-si x resections were performed (27 retroperitoneal interventions, 21 thor acotomies, 4 resections of hepatic lesions, 3 neck dissections, 1 cran iotomy). No surgery-related mortality was observed. 8 patients (30%) s howed dissimilar histological findings at sequential or one-stage rese ctions. 5 of these demonstrated less favourable pathological features (mature teratoma or undifferentiated tumour) at the second operation, while only necrosis (n = 3) or teratoma (n = 2) had been found followi ng the first operation. Tumour necrosis was documented more frequently at thoracotomy (n = 15/21) compared to retroperitoneal lymph node exc ision (n = 17/27). By univariate analysis, completeness of surgery (RO resection) and the histological finding of necrosis or differentiated teratoma were associated with improved relapse-free and overall survi val. After a median follow-up period of 33 months (range 1-167), 19 of 26 (73%) evaluable patients are alive; 18 of 27 (67%) patients have c ontinuous no evidence of disease (1 patient with recurrent disease was lost to follow-up). Since the histological findings in postchemothera py residuals may vary between different anatomical sites and no predic tion seems possible, patients are best managed by excision of all pres ent tumour masses if technically feasible. Necrosis identified at thor actomy should not lead to omission of retroperitoneal lymph node resec tion since there was, in accordance to other authors, a trend that the retroperitoneum harbours unfavourable histological findings more freq uently. (C) 1997 Elsevier Science Ltd.