Management of disseminated nonseminomatous germ cell tumors with risk-based chemotherapy followed by response-guided postchemotherapy surgery.

Abstract

PURPOSE:

The management of patients with a radiographic complete response after chemotherapy remains controversial. The current study assesses the outcome for a modern, unselected patient population with disseminated testicular cancer with particular emphasis on those achieving a radiographic complete remission to combination chemotherapy.

PATIENTS AND METHODS:

All patients with disseminated nonseminoma seen between 1999 and 2007 at the British Columbia Cancer Agency (BCCA) as well as through the Oregon Testis Cancer Program were retrospectively reviewed. A total of 276 patients treated with combination chemotherapy were identified. A radiographic complete remission (CR) was defined as disappearance of all metastatic lesions or minimal residual tissue <or= 1 cm.

RESULTS:

One hundred sixty-one patients achieved a CR. Results for the total population and CR subset were as follows: International Germ Cell Cancer Consensus Group stage good/intermediate/poor 84%/5%/11% (CR subset, 94%/3%/3%), presence of teratoma in the primary tumor 40% (CR subset, 55%), relapses 13%, death from disease 3% (CR subset, 6% and 0%, respectively). Two of the total 10 relapses in the CR group occurred beyond 2 years. Eight of the 10 relapses in the CR group were treated surgically for teratoma alone, whereas two required salvage chemotherapy. Disease-specific survival for the CR group was 100% after a median follow-up of 52 months (range, 3 to 135 months).

CONCLUSION:

Modern risk-adapted systemic chemotherapy with or without surgery for current populations of patients with disseminated testicular nonseminoma results in superb outcomes. Patients with disseminated germ cell tumors who obtain a complete serologic remission and no or minimal radiographic residual can be safely observed without adjunctive regional surgery.

• Authors: Christian Kollmannsberger, Siamak Daneshmand, Alan So, Kim N Chi, Nevin Murray, Christie Moore, Brandon Hayes-Lattin, Craig Nichols
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 28 Issue 4 Pg. 537-42 (Feb 01 2010) ISSN: 1527-7755 [Electronic] United States
• PMID: 20026807 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local (diagnostic imaging)
• Radiography, Thoracic
• Remission Induction
• Retrospective Studies
• Risk Factors
• Teratoma (diagnostic imaging, drug therapy, pathology)
• Testicular Neoplasms (diagnostic imaging, drug therapy, pathology)
• Tomography, X-Ray Computed
• Treatment Outcome
• Young Adult