Patient selection for retroperitoneal lymph node dissection after chemotherapy for nonseminomatous germ cell tumors Journal Article
| Authors: | Herr, H. W.; Toner, G. C.; Geller, N. L.; Bosl, G. J. |
| Article Title: | Patient selection for retroperitoneal lymph node dissection after chemotherapy for nonseminomatous germ cell tumors |
| Abstract: | The indications for retroperitoneal lymph node dissection (RPLND) after chemotherapy for nonseminomatous germ cell tumor of the testis vary widely. We reviewed our experience with 122 patients who underwent RPLND within 6 months of receiving cisplatin-based chemotherapy for bulky (> 3 cm) retroperitoneal metastases. Pathologic findings were necrotic tissue in 57 (47%), teratoma in 48 (39%), and residual malignancy in 17 (14%). The size of the retroperitoneal mass after chemotherapy (p = 0.001) and the degree of shrinkage that occurred with chemotherapy (p = 0.0001) were both strongly correlated with the histologic findings at RPLND. The presence or absence of teratomatous elements in the pretreatment orchiectomy specimens was only weakly correlated (p = 0.06). Multivariate logistic regression found shrinkage and the size of the residual mass to be independent predictors of finding only necrotic tissue. We were unable to identify preoperatively a group of patients in which some did not have teratoma or malignancy ultimately resected. Of 39 patients who had a residual mass < 1.5 cm, and 43 patients whose residual mass was < 1.5 cm or whose mass had shrunk by 90%, 3 had residual malignancy, and 5 had teratoma resected. Among these 8 patients, 7 had prechemotherapy masses > 3 cm. Even with stricter criteria, of 17 patients with no testis teratoma initially and a residual mass < 1.5 cm which had shrunk by > 90%, 5 (30%) had teratoma or malignancy resected. Postchemotherapy RPLND is recommended for all patients with a prechemotherapy mass ≥ 3 cm, irrespective of the radiographic findings. |
| Keywords: | major clinical study; cisplatin; chemotherapy; lymph node dissection; lymphadenectomy; testis tumor; surgery; teratoma; testis cancer; non seminomatous germinoma; retroperitoneum; human; male; priority journal; article |
| Journal Title: | European Urology |
| Volume: | 19 |
| Issue: | 1 |
| ISSN: | 0302-2838 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 1991-01-01 |
| Start Page: | 1 |
| End Page: | 5 |
| Language: | English |
| DOI: | 10.1159/000473567 |
| PUBMED: | 1848821 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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