Postchemotherapy surgery in nonseminomatous testicular tumors

Two hundred and twenty patients with metastatic nonseminomatous germ cell testicular tumors received primary chemotherapy including cisplatin, vinblastine and bleomycin (PVB). Complete response was achieved with chemotherapy alone in 108 (49.1%) patients. Postchemotherapy surgery of the residual mass was done in 85 (38.6%) patients with normalized serum tumor markers. Laparotomy was done in 62 patients, 19 patients underwent thoracic surgery, and 4 patients had both postchemotherapy treatments. Thirteen (5.9%) patients had persistently elevated serum tumor markers, they died despite salvage second-line chemotherapy. Fourteen (6.4%) patients died during primary PVB chemotherapy. The masses removed at laparotomy consisted of necrotic and/or fibrotic tissue in 25.8%, mature teratoma in 61.3% and viable cancer was detected in 12.9% of cases. In contrast, resected pulmonary masses consisted of necrotic and/or fibrotic tissue in 42.1%, mature teratoma in 26.3% and viable cancer in 31.6%. The total therapeutic outcome in 220 patients was as follows: 159 (72.3%) patients are alive and free of disease; 4 (1.8%) patients live with disease, and 57 (25.9%) died of the disease.