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Surgery as salvage therapy in chemotherapy-resistant nonseminomatous germ cell tumours
1Royal London Hospital School of Medicine and Dentistry, UK.
Objective:
To review our experience of surgical staging for residual masses after chemotherapy in patients with nonseminomatous germ cell tumour (NSGCT) and positive tumour markers.
Patients And Methods:
Of 107 patients with metastatic NSGCTs treated surgically after chemotherapy from 1978 to 1995, 30 (median age 30.5 years, range 20-52) had positive tumour markers. These patients were reviewed and the outcome compared with 77 patients who had normal tumour marker values.
Results:
Of the 77 patients with negative markers undergoing surgical/pathological staging, 71 (92%) became continuously disease-free, including 37 of 50 (74%) with viable NSGCT in excised specimens. Seventeen of 30 (57%) with raised marker levels undergoing similar surgery for chemotherapy-resistant tumour became disease-free, including 11 of 22 with viable NSGCT in the excised specimens.
Conclusion:
Although the outcome after surgery is better in patients with negative tumour markers, it is clear that surgery is curative for patients with localized chemotherapy-resistant masses. There is a need for continued debate on the timing of salvage surgery and subsequent chemotherapy.
Insights
Surgical staging is effective for nonseminomatous germ cell tumors (NSGCT) residual masses post-chemotherapy. Surgery offers a curative option for chemotherapy-resistant NSGCT, even with positive tumor markers.
Area of Science:
- Oncology
- Surgical Oncology
- Genitourinary Cancer
Background:
- Nonseminomatous germ cell tumors (NSGCT) often require chemotherapy followed by surgical intervention for residual masses.
- Tumor markers play a crucial role in monitoring treatment response and guiding further management in NSGCT patients.
Purpose of the Study:
- To evaluate the efficacy of surgical staging for residual masses in nonseminomatous germ cell tumors (NSGCT) patients with positive tumor markers after chemotherapy.
- To compare outcomes between NSGCT patients with positive and negative tumor markers undergoing surgical staging.
Main Methods:
- Retrospective review of 107 metastatic NSGCT patients treated surgically post-chemotherapy (1978-1995).
- Analysis of 30 patients with positive tumor markers and comparison with 77 patients with normal tumor marker values.
Main Results:
- Patients with negative tumor markers undergoing surgical staging had a 92% disease-free rate.
- Seventeen of 30 (57%) patients with positive tumor markers and chemotherapy-resistant NSGCT achieved disease-free status after surgery, including 11 with viable tumor in excised specimens.
Conclusions:
- Surgical staging is a curative treatment for localized chemotherapy-resistant NSGCT masses, even with elevated tumor markers.
- While outcomes are better with negative markers, surgery remains a vital option for positive marker NSGCT patients.
- Further discussion is needed regarding optimal timing for salvage surgery and adjuvant chemotherapy in NSGCT management.
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