Outcomes after resection of postchemotherapy residual neck mass in patients with germ cell tumors-An update Journal Article

Authors: Gupta, A.; Feifer, A. H.; Gotto, G. T.; Kraus, D.; Motzer, R.; Bosl, G. J.; Bajorin, D.; Feldman, D. R.; Carver, B.; Sheinfeld, J.
Article Title: Outcomes after resection of postchemotherapy residual neck mass in patients with germ cell tumors-An update
Abstract: Objective To examine histologic findings and clinical outcomes of patients whounderwent neck dissection for residual neck masses. Methods From 1987 to 2008, 968 postchemotherapy retroperitoneal lymph node dissections (RPLND) were performed at our institution. We identified 41 of these patients who underwent a postchemotherapy residual neck mass resection. Results Thirty-nine patients presented with primary testis, one with retroperitoneal, and one with mediastinal GCT. Teratoma was present in 54% of patients at diagnosis. During the neck dissection, 23 (56.1%) patients had teratoma, 14 (34.2%) had fibrosis, three (7.3%) had viable GCT, and one had benign lymph nodes. There was histologic discordance between the neck and the RPLND in 22.5% of patients and between the neck and other extraretroperitoneal resection sites in 26.5% of patients. At a median follow-up of 49.5 months from diagnosis, 16 patients had recurrence, and seven had died of testis cancer. No patient had recurrence in the neck. Five of seven patients with residual viable cancer at extraretroperitoneal resection sites died of disease compared with two of 23 with teratoma and none with fibrosis (P = .0005). Conclusions Resection of residual postchemotherapy neck masses is indicated because of the high incidence of viable tumor or teratoma in the residual mass and the inability to accurately predict the histology of the neck masses. Resection of residual neck masses leads to excellent local control and can contribute to long-term disease control and survival. © 2011 Elsevier Inc.
Keywords: adolescent; adult; clinical article; controlled study; treatment outcome; middle aged; young adult; histopathology; cancer recurrence; neck dissection; postoperative period; cisplatin; combined modality therapy; lymph node dissection; lymphatic metastasis; lymph node excision; carboplatin; etoposide; ifosfamide; death; minimal residual disease; neoplasm, residual; testicular neoplasms; bleomycin; teratoma; retroperitoneal tumor; neoplasms, germ cell and embryonal; retroperitoneal neoplasms; orchiectomy; testis cancer; germ cell tumor; mediastinal neoplasms; retroperitoneal space; mediastinum cancer; neck tumor
Journal Title: Urology
Volume: 77
Issue: 3
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2011-03-01
Start Page: 655
End Page: 659
Language: English
DOI: 10.1016/j.urology.2010.10.002
PUBMED: 21377010
PROVIDER: scopus
Notes: --- - "Export Date: 23 June 2011" - "CODEN: URGYA" - "Source: Scopus"
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MSK Authors
  1. Dean Bajorin
    416 Bajorin
  2. Robert Motzer
    769 Motzer
  3. Dennis Kraus
    259 Kraus
  4. Darren Richard Feldman
    172 Feldman
  5. Joel Sheinfeld
    197 Sheinfeld
  6. Andrew Feifer
    18 Feifer
  7. Geoffrey Thomas Gotto
    9 Gotto
  8. Amit Gupta
    10 Gupta
  9. Brett Stewart Carver
    109 Carver
  10. George Bosl
    270 Bosl