Tumor marker levels in post-chemotherapy cystic masses: Clinical implications for patients with germ cell tumors Journal Article

Authors: Beck, S. D. W.; Patel, M. I.; Sheinfeld, J.
Article Title: Tumor marker levels in post-chemotherapy cystic masses: Clinical implications for patients with germ cell tumors
Abstract: Purpose: Increased tumor markers after induction chemotherapy for patients with germ cell tumor usually represent systemic disease and consequently second line chemotherapy is instituted, while retroperitoneal lymph node dissection (RPLND) is reserved for patients with marker normalization. We report the concentration of α-fetoprotein (AFP) and human chorionic gonadotropin (HCG) in the fluid of post-chemotherapy cystic masses to evaluate this as a potential source for serum marker elevation. Materials and Methods: From March 2002 to December 2002, 11 consecutive patients with post-chemotherapy cystic masses underwent RPLND. Following resection, aspirated fluid was analyzed for AFP and HCG. Only 5 post-chemotherapy RPLNDs were performed in patients with increased serum tumor markers, including the 3 patients in our study. Patients with increasing tumor markers and/or multifocal disease with noncystic residual masses after induction chemotherapy underwent salvage chemotherapy despite teratomatous elements in the primary tumor. Results: All 11 patients had teratoma in the orchiectomy specimen and retroperitoneum, including one with malignant transformation. Cystic fluid markers were increased in all patients, 9 of 9 with HCG (range 7.0 to 6,880) and 9 of 11 with AFP (27.5 to 521.2). Two patients with an increased serum AFP before surgery (47.9 and 31.6) had cyst levels of 73.5 and 790.4 respectively. Both serum markers normalized postoperatively. One patient with increased pre-RPLND serum HCG (11.6) had a cyst level of 233. HCG continued to increase postoperatively and the patient died of disease. The remaining 10 patients remain disease free. Conclusion: Fluid from cystic teratoma contains variably elevated levels of HCG and AFP in all patients and appears to be independent of serum marker level or pathology. It is possible that a "slow leak" of fluid from cystic teratoma may explain elevated serum markers in selected patients with teratoma and thus may potentially avoid second line chemotherapy.
Keywords: cancer chemotherapy; clinical article; cisplatin; lymph node dissection; paraaortic lymph node; lymph node excision; etoposide; cyst fluid; tumor markers, biological; tumor marker; testicular neoplasms; bleomycin; teratoma; orchiectomy; malignant transformation; germ cell tumor; yolk sac tumor; retroperitoneum; alpha fetoprotein; chorionic gonadotropin; retroperitoneal space; cyst; cysts; testis teratoma; germinoma; alpha-fetoproteins; humans; human; male; priority journal; article; testicular diseases
Journal Title: Journal of Urology
Volume: 171
Issue: 1
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2004-01-01
Start Page: 168
End Page: 171
Language: English
DOI: 10.1097/01.ju.0000099714.16082.78
PROVIDER: scopus
PUBMED: 14665869
Notes: J. Urol. -- Cited By (since 1996):18 -- Export Date: 16 June 2014 -- CODEN: JOURA -- Source: Scopus
Citation Impact
MSK Authors
  1. Stephen David Wilson Beck
    5 Beck
  2. Manish Patel
    11 Patel
  3. Joel Sheinfeld
    241 Sheinfeld