Residual Tumor Resection After High-Dose Chemotherapy in Patients With Relapsed or Refractory Germ Cell Cancer

Purpose To assess the role of residual tumor resection performed after high-dose chemotherapy (HDCT) in patients with relapsed or refractory germ cell tumors (GCT). Patients and Methods Between July 1987 and October 1999, postchemotherapy resections of residual tumors were performed in 57 patients who had been treated with HDCT for relapsed or refractory GCT and who had achieved a partial remission to this treatment. Results Complete resections of residual masses were achieved in 52 (91%) of 57 patients who were rendered disease free; in five (9%) of 57 patients, the resections were incomplete. Resection of a single site was performed in 39 (68%) of 57 patients, and the remaining 18 (32%) of 57 patients required interventions at two or more residual tumor sites. Necrosis was found in 22 (38%) of 57 patients, mature teratoma with or without necrosis was found in nine (16%) of 57 patients, and viable cancer with or without additional necrosis or mature teratoma was found in 26 (46%) of 57 patients. Viable cancer consisted either of residual germ cell or undifferentiated cancer in 22 (85%) of 26 patients, with additional non-GCT histologies in the remaining four patients. Patients with viable cancer had a significantly inferior outcome after surgery compared with patients with necrosis and/or mature teratoma even if all cancer was completely resected. Pulmonary lesions with a diameter of more than 2 cm were the only predictive variable for viable cancer in univariate analysis. Conclusion Resections of all residual tumors should be attempted in patients with relapsed or refractory GCT and partial remissions after HDCT.

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Residual tumor resection after high-dose chemotherapy in patients with relapsed or refractory germ cell cancer

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2005.01.006 ◽

2005 ◽

Vol 23 (2) ◽

pp. 137

Author(s):

Jerome P. Richie

Keyword(s):

Germ Cell ◽

Cell Cancer ◽

Tumor Resection ◽

Residual Tumor ◽

High Dose Chemotherapy ◽

Germ Cell Cancer ◽

High Dose ◽

Residual Tumor Resection

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The Role of Residual Tumor Resection in the Management of Nonseminomatous Germ Cell Cancer of Testicular Origin

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0031-1299584 ◽

2012 ◽

Vol 60 (06) ◽

pp. 405-412 ◽

Cited By ~ 18

Author(s):

Joachim Schirren ◽

Stephan Trainer ◽

Michael Eberlein ◽

Anja Lorch ◽

Jörg Beyer ◽

...

Keyword(s):

Germ Cell ◽

Cell Cancer ◽

Tumor Resection ◽

Residual Tumor ◽

Germ Cell Cancer ◽

Residual Tumor Resection

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180P THE ROLE OF RESIDUAL TUMOR RESECTION IN THE MANAGEMENT OF METASTATIC NONSEMINOMATOUS GERM CELL CANCER OF TESTICULAR ORIGIN

Lung Cancer ◽

10.1016/s0169-5002(09)70303-4 ◽

2009 ◽

Vol 64 ◽

pp. S73-S74

Author(s):

J. Schirren ◽

S. Trainer ◽

A. Fisseler-Eckhoff ◽

S. Bölükbas

Keyword(s):

Germ Cell ◽

Cell Cancer ◽

Tumor Resection ◽

Residual Tumor ◽

Germ Cell Cancer ◽

Residual Tumor Resection

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Complications of postchemotherapy residual tumor resection in patients with germ cell cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16077 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16077-e16077 ◽

Cited By ~ 3

Author(s):

P. Albers ◽

C. Bingöl ◽

R. Witthuhn ◽

P. de Geeter

Keyword(s):

Germ Cell ◽

Tumor Size ◽

Cell Cancer ◽

Tumor Resection ◽

Residual Tumor ◽

Nerve Sparing ◽

Tumor Diameter ◽

Residual Tumor Resection ◽

Residual Tumor Size ◽

Extent Of Surgery

e16077 Background: Residual tumor resection (RTR) is mandatory in all patients with advanced germ cell tumors and visible residual disease after chemotherapy. Full bilateral RTR is the proposed standard of care. However, in lately published series, the rate of nerve-sparing procedures was only 40%. Stage-related RTR may decrease surgical complications, enhance the rate of postoperative antegrade ejaculations and may not compromise oncological efficacy. Methods: A retrospective analysis of 98 patients in a tertial referral center with RTR (2003–2008) was performed using the RTR database and patients´ charts to correlate the extent of surgery to complications and outcome. Results: 49% of patients initially had IGCCCG intermediate and poor prognosis features. In 34%, residual tumor diameter was >5 cm. With a median age of 33 yrs (17–65), the median time of surgery was 210 min (90–604) with a median blood loss of 500 cc (50–5000). In 25 of 98 patients a full bilateral RTR was necessary to remove all residual tumors. The median residual tumor diameter in patients with full bilateral RTR without nerve-sparing was 10.9 cm (1.5–30) as opposed to 4.3 cm (0.5–20) in patients with modified template and/or nerve-sparing approaches (not significant). In 10 pts a nephrectomy and in 9 pts a resection of the vena cava was necessary. Only 2 of each had a bilateral RTR. All CTCAE grade III/VI complications like intraoperative hemorrhage (n=25, 11/25 bilateral RTR), postoperative lymphocele (n=8, 6/8 bilateral RTR), and retrograde ejaculation (15% with modified template and/or nerve-sparing, 100% with bilateral RTR) were significantly correlated with the residual tumor size and with the field of resection. Four patients relapsed, one had an in-field relapse after a template resection. One patient died due to a postoperative aorto-duodenal fistula. Conclusions: The complication rate of RTR is strongly related to the median residual tumor size and the extent of surgery. A full bilateral resection in all patients may result in unnecessary complications in a considerable cohort of patients. The field of resection should be adapted to the primary localization of disease and full bilateral resections should be performed only in patients with bilateral disease. No significant financial relationships to disclose.

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High-Dose Chemotherapy with Stem Cell Rescue for Germ Cell Cancer

Current Controversies in Bone Marrow Transplantation ◽

10.1007/978-1-59259-657-7_16 ◽

2000 ◽

pp. 217-226

Author(s):

E. Randolph Broun

Keyword(s):

Stem Cell ◽

Germ Cell ◽

Cell Cancer ◽

High Dose Chemotherapy ◽

Germ Cell Cancer ◽

High Dose ◽

Stem Cell Rescue

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A multi-center prospective phase II study of high-dose chemotherapy in germ-cell cancer patients relapsing from complete remission

Annals of Oncology ◽

10.1023/a:1008328012040 ◽

1999 ◽

Vol 10 (12) ◽

pp. 1467-1474 ◽

Cited By ~ 45

Author(s):

S. Rodenhuis ◽

R. de Wit ◽

P.H.M. de Mulder ◽

H.J. Keizer ◽

D.T. Sleijfer ◽

...

Keyword(s):

Complete Remission ◽

Germ Cell ◽

Cancer Patients ◽

Phase Ii ◽

Phase Ii Study ◽

Cell Cancer ◽

High Dose Chemotherapy ◽

Germ Cell Cancer ◽

High Dose ◽

Prospective Phase

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A randomized trial of standard chemotherapy v a high-dose chemotherapy regimen in the treatment of poor prognosis nonseminomatous germ-cell tumors.

Journal of Clinical Oncology ◽

10.1200/jco.1988.6.6.1031 ◽

1988 ◽

Vol 6 (6) ◽

pp. 1031-1040 ◽

Cited By ~ 167

Author(s):

R F Ozols ◽

D C Ihde ◽

W M Linehan ◽

J Jacob ◽

Y Ostchega ◽

...

Keyword(s):

Germ Cell ◽

Dose Regimen ◽

Standard Therapy ◽

Poor Prognosis ◽

Cell Cancer ◽

Germ Cell Tumors ◽

High Dose Chemotherapy ◽

High Dose ◽

High Dose Regimen ◽

Disease Free

We performed a prospective randomized trial of a high-dose chemotherapy regimen v standard cisplatin-based chemotherapy in poor prognosis nonseminomatous germ-cell cancer patients. The high-dose regimen consisting of twice the standard dose of cisplatin (P), along with vinblastine (Ve), bleomycin (B), and the epipodophylotoxin etoposide (VP-16) (V) (PVeBV) was compared to the classic regimen with normal dose cisplatin, vinblastine, and bleomycin (PVeB). Eligibility criteria included large abdominal masses, liver metastases, multiple pulmonary metastases, brain metastases, marked elevations in serum tumor markers (alpha-fetoprotein greater than 1,000 ng/mL or the beta-subunit of human chorionic gonadotropin greater than 10,000 mIU), unfavorable histology (pure choriocarcinoma), or extragonadal germ-cell tumors. Fifty-two consecutive patients with poor prognostic features were randomized to receive either PVeBV or PVeB. The median follow-up is 4 years. Treatment with the high-dose regimen increased the complete remission rate (88% v 67%, P = .14) and was associated with a lower relapse rate (17% v 41%, P = .2). The median survival of patients receiving standard therapy was 30 months, while the median survival for patients receiving the high-dose regimen has not been reached. Actuarial 5-year survival for patients treated with the high-dose regimen is 78%, compared with 48% for patients receiving standard therapy (two-sided Mantel-Cox test = .06). Disease-free survival was also superior for patients randomized to PVeBV (P = .03). Sixty-eight percent of patients (23 of 34) randomized to PVeBV are alive and continuously disease-free, compared with 33% (six of 18) for PVeB (P = .02). The major difference in toxicity between the high-dose regimen and standard therapy was the severity of myelosuppression and the incidence of severe hearing loss. Ninety-one percent of patients treated with PVeBV had a WBC count less than 1,000/microL, compared with 50% of patients receiving PVeB (P less than .05). Hearing aids were recommended for 12 patients who received PVeBV and two who received PVeB. The increased effectiveness of the PVeBV regimen in poor prognosis germ-cell cancer patients may relate to the double-dose cisplatin, the addition of VP-16, or to a synergistic effect of these two drugs.

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