Surgical management of patients with advanced germ cell tumors following salvage chemotherapy: Memorial Sloan Kettering Cancer Center (MSKCC) experience Journal Article


Authors: Miller, M. I.; Feifer, A.; Feldman, D. R.; Carver, B. S.; Bosl, G. J.; Motzer, R. J.; Bajorin, D. F.; Sheinfeld, J.
Article Title: Surgical management of patients with advanced germ cell tumors following salvage chemotherapy: Memorial Sloan Kettering Cancer Center (MSKCC) experience
Abstract: Objective: To characterize clinical and pathologic outcomes of cisplatin-refractory or relapsed germ cell tumor (GCT) patients who underwent retroperitoneal lymph node dissection (RPLND) following salvage chemotherapy with either conventional or high dose regimens. Methods: Data were reviewed to identify all patients treated with TIP or TICE salvage chemotherapy between 1994 and 2011(n = 184) at our institution. We report clinicopathologic and outcomes data on 131 patients who were further managed with surgical resection. Using Cox-proportional hazards models, predictors of disease-specific survival (DSS) were analyzed. Results: Median follow-up was 7.3 years. Of the 112 patients who underwent postsalvage chemotherapy RPLND, histology was reported as viable GCT in 30 (27%), teratoma only in 26 (23%) and fibrosis in 56 (50%). 5-year DSS for the entire cohort was 74% (95% confidence interval 63%-80%). On multivariable analysis, viable GCT histology at RPLND or extra-RPLND resection predicted for worse DSS (hazard ratio 7.37, P =.003). Conclusions: Our data suggest that approximately half of the patient with cisplatin-refractory or relapsed GCT salvaged with TIP or TICE chemotherapy and evidence of residual disease are at risk of harboring either viable GCT or teratoma. This finding underlines the critical role of surgery in the multimodality approach to the management of this advanced disease entity. If retroperitoneal disease exists prior to salvage chemotherapy, we recommend postchemotherapy resection in all eligible patients. © 2018 Elsevier Inc.
Keywords: adult; cancer chemotherapy; major clinical study; clinical feature; histopathology; cancer recurrence; salvage therapy; cisplatin; paclitaxel; radiation dose; follow up; lymph node dissection; carboplatin; etoposide; cohort analysis; ifosfamide; fibrosis; teratoma; germ cell tumor; disease specific survival; clinical outcome; human; priority journal; article
Journal Title: Urology
Volume: 124
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2019-01-01
Start Page: 174
End Page: 178
Language: English
DOI: 10.1016/j.urology.2018.09.024
PUBMED: 30296502
PROVIDER: scopus
DOI/URL:
Notes: Source: Scopus
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MSK Authors
  1. Dean Bajorin
    413 Bajorin
  2. Robert Motzer
    762 Motzer
  3. Darren Richard Feldman
    172 Feldman
  4. Joel Sheinfeld
    197 Sheinfeld
  5. Andrew Feifer
    18 Feifer
  6. Brett Stewart Carver
    109 Carver
  7. George Bosl
    262 Bosl