Long-term results of combined treatment of patients with advanced testicular germ-cell tumors
Article published in Urologia Polska 2007/60/3.

authors

Adam Płużański, Leszek Jeromin, Anna Płużańska, Marek Sosnowski: Klinika Chemioterapii Katedry Onkologii Uniwersytetu Medycznego w Łodzi
II Klinika Urologii Katedry Urologii Uniwersytetu Medycznego w Łodzi
I Klinika Urologii Katedry Urologii Uniwersytetu Medycznego w Łodzi

keywords

testis, testicular germ-cell tumor, treatment, chemotherapy, retroperitoneal lymph node dissection

summary

Introduction. Chemotherapy is the treatment of choice in advanced testicular germ-cell tumors (TGCT) with retroperitoneal metastases. It enables to obtain complete or partial remission of these lesions. In some patients with residual lesions in the retroperitoneal region, their surgical removal- retroperitoneal lymphadenectomy (RPLND) is important element of the treatment. The aim of the study. Retrospective analysis of treatment results in patients with advanced TGCT, who underwent RPLND due to the presence of residual lesions in the retroperitoneal space after chemotherapy.

Material and method. The study was carried out in a group of 45 patients with advanced stages of TGCT (36 - IIB/IIC and 9 - III) after retroperitoneal lymphadenectomy, in whom complete remission was not obtained after initial cytostatic treatment. The analysis included 39 patients after radical resection of residual masses and evaluation of the correlation between relapse of the disease and the histopathological results of the resected tumor and other selected clinical parameters. Median observation time was 72 months.

Results. Histological evaluation of the resected lesions revealed the presence of viable tumor cells in 12 (31%) patients, necrosis in 19 (49%) and elements of differentiated teratoma in 8 (20%). Teratomas were detected in 50% of patients in whom the elements of teratoma was observed in the primary tumor. Relapse after RPLND was observed in 5 patients with viable tumor cells and in 5 with teratoma elements or necrosis. Irrespective of histopathology results, relapse occurred in 7 out of 18 patients with lymph node diameter exceeding 5 cm prior to RPLND and in 3 out of 6 with elevated tumor marker values persistent after chemotherapy. In the treatment group, 35 (90%) out of 39 patients who underwent RPLND are still alive.

Conclusions. Retroperitoneal lymphadenectomy of residual lesions after chemotherapy plays an important role in the treatment of patients with advanced TGCT. Persistent elevated tumor markers after chemotherapy, lymph node dimensions >5 cm and the presence of active tumor cells in lesions resected during RPLND are associated with increased risk of TGCT relapse.

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