Incidence of metastatic nonseminomatous germ cell tumor outside the boundaries of a modified postchemotherapy retroperitoneal lymph node dissection Journal Article


Authors: Carver, B. S.; Shayegan, B.; Eggener, S.; Stasi, J.; Motzer, R. J.; Bosl, G. J.; Sheinfeld, J.
Article Title: Incidence of metastatic nonseminomatous germ cell tumor outside the boundaries of a modified postchemotherapy retroperitoneal lymph node dissection
Abstract: Introduction: Modified template retroperitoneal lymph node dissections (RPLND) have become increasing applied in the postchemotherapy (PC) setting. We evaluated our experience with PC-RPLND to determine the incidence of disease extending outside the boundaries of a modified PC-RPLND. Patients and Methods: From 1989 through 2003, a total of 532 men underwent PC-RPLND for metastatic nonseminomatous germ cell tumor (NSGCT). Of these, 269 (51%) had either viable germ cell tumor (GCT) or teratoma present in the RPLND specimen. After Institutional Review Board approval, clinical and pathologic data were obtained from our prospective surgical database. The incidence of retroperitoneal disease outside the boundaries of five modified templates was reported for the presence of viable GCT or teratoma. Results: Of the 269 patients with viable GCT or teratoma, 20 to 86 (7% to 32%) patients had evidence of extratemplate retroperitoneal disease, depending on the boundaries of the modified template. There was no difference in the histologic distribution for patients with disease confined to or outside of the modified templates. Despite the absence of preoperative radiographic evidence of disease outside the boundaries of the Testicular Tumor Study Group template, the incidence of extratemplate metastasis for men with residual retroperitoneal masses less than 1, 1 to 2, 2 to 5, and more than 5 cm was two of 24 (8%), seven of 38 (18%), 27 of 92 (29%), and 14 of 55 (25%), respectively. Conclusion: Our data suggest a bilateral RPLND is a prudent approach for the management of men with metastatic NSGCT after chemotherapy, given that at least 7% to 32% of men will have teratoma or viable GCT outside the boundaries of a modified template. © 2007 by American Society of Clinical Oncology.
Keywords: cancer chemotherapy; major clinical study; multimodality cancer therapy; antineoplastic agents; united states; preoperative care; combined modality therapy; methodology; antineoplastic agent; cancer incidence; lymph node dissection; prospective study; lymph node excision; neoplasm; lymphadenectomy; metastasis; incidence; pathology; data base; histology; sexual dysfunction; statistical analysis; clinical study; minimal residual disease; neoplasm, residual; testis tumor; testicular neoplasms; teratoma; retroperitoneal tumor; neoplasms, germ cell and embryonal; retroperitoneal neoplasms; germ cell tumor; radiodiagnosis; non seminomatous germinoma; retroperitoneum; retroperitoneal space; sexual dysfunction, physiological; institutional review; retroperitoneal disease; modified postchemotherapy retroperitoneal lymph node dissection
Journal Title: Journal of Clinical Oncology
Volume: 25
Issue: 28
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2007-10-01
Start Page: 4365
End Page: 4369
Language: English
DOI: 10.1200/jco.2007.11.2078
PUBMED: 17906201
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 45" - "Export Date: 17 November 2011" - "CODEN: JCOND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Robert Motzer
    790 Motzer
  2. Joel Sheinfeld
    202 Sheinfeld
  3. Brett Stewart Carver
    109 Carver
  4. George Bosl
    281 Bosl
  5. Jason Stasi
    25 Stasi
  6. Scott Egon Eggener
    35 Eggener