SURGICAL RESECTION IN PATIENTS WITH NONSEMINOMATOUS GERM-CELL TUMOR WHO FAIL TO NORMALIZE SERUM TUMOR-MARKERS AFTER CHEMOTHERAPY

Objective. Patients with high-stage nonseminomatous germ cell tumors treated with platinum-based chemotherapy who have residual radiographic evidence of disease and fail to normalize tumor markers present a difficult clinical dilemma. Some authors feel that these patients are not appropriate surgical candidates. Our practice has been to offer certain patients salvage surgery in an attempt for cure, this report is designed to review that experience and critically analyze the results. Method. We report a series of 16 such patients with advanced-stage nonseminomatous germ tell tumors who had persistently elevated alpha fetoprotein and/or human chorionic gonadotropin. All underwent resection of all radiographically evident sites of residual disease following induction or salvage chemotherapy. Results. Ten patients had only retroperitoneal (RP) metastasis. Six patients had more than one site of residual disease-4 RP and lung, 2 RP and liver. There were no postoperative deaths. The mean postoperative stay was eleven days (range 7 to 36 days). Six patients (37%) are alive and free of disease at a mean of seventy-four months following surgery (range 20 to 145 months). Five had RP disease only. Ten patients died of disease at a mean of eight months postoperatively (range 5 to 21 months). Conclusions. Patients with advanced nonseminomatous germ cell tumor who fail to normalize their serum tumor markers after adequate platinum-based chemotherapy should be considered for surgical resection of all radiographically evident residual disease. In select cases this practice offers the only viable chance for cure.