Management of residual mass in advanced seminoma: Results and recommendations from the Memorial Sloan-Kettering Cancer Center Journal Article

Authors: Puc, H. S.; Heelan, R.; Mazumdar, M.; Herr, H.; Scheinfeld, J.; Vlamis, V.; Bajorin, D. F.; Bosl, G. J.; Mencel, P.; Motzer, R. J.
Article Title: Management of residual mass in advanced seminoma: Results and recommendations from the Memorial Sloan-Kettering Cancer Center
Abstract: Purpose: Guidelines for management of postchemotherapy residual mass in patients with advanced seminoma remain controversial. We sought to characterize independent prognostic factor(s) for persistence of tumor to identify patients with a high risk of residual carcinoma. Patients and Methods: One hundred four patients with advanced seminoma were assessed. All had achieved a complete response or partial response with normal markers to induction cisplatin-based chemotherapy and had radiographs available for review. Selected prechemotherapy and postchemotherapy characteristics were compared for patients who had either germ cell tumor histology at surgery or relapsed at the assessed site (defined as site failure) versus those who had only necrosis or fibrosis found at surgery and did not relapse at the assessed site (defined as site nonfailure). Results: At a median follow-up time of 47 months(range, 5 to 153), 94 patients (90%) were designated as site nonfailures and 10 (10%) as site failures. Site failure correlated only with size of the residual mass (< 3 cm or normal v ≥ 3 cm; P = .0006). Two of 74 patients (3%) with residual masses less than 3 cm were considered site failures, compared with eight of 30 (27%) with residual masses ≥ 3 cm. Conclusion: Patients with advanced seminoma who have normal radiographs or residual masses less than 3 cm after chemotherapy can be observed without further intervention. The following three options exist for patients with a residual mass ≥ 3 cm: observation, radiotherapy, or surgical intervention. We prefer the latter to define response, resect viable tumor when possible, and direct further treatment.
Keywords: adolescent; adult; cancer chemotherapy; cancer survival; child; school child; treatment outcome; aged; middle aged; major clinical study; cisplatin; advanced cancer; cancer risk; combined modality therapy; medical decision making; tumor volume; neoplasm, residual; cancer size; testicular neoplasms; seminoma; humans; human; male; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 14
Issue: 2
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1996-02-01
Start Page: 454
End Page: 460
Language: English
PUBMED: 8636757
PROVIDER: scopus
DOI: 10.1200/JCO.1996.14.2.454
Notes: Article -- Export Date: 22 November 2017 -- Source: Scopus
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MSK Authors
  1. Dean Bajorin
    416 Bajorin
  2. Robert Motzer
    769 Motzer
  3. Madhu Mazumdar
    125 Mazumdar
  4. Harry W Herr
    407 Herr
  5. George Bosl
    270 Bosl
  6. Robert T Heelan
    85 Heelan
  7. Vaia   Vlamis
    29 Vlamis