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Management of Post-Chemotherapy Residual Masses in Advanced Seminoma

2002; Lippincott Williams & Wilkins; Volume: 168; Issue: 5 Linguagem: Inglês

10.1016/s0022-5347(05)64275-9

1527-3792

Aude Fléchon, Emmanuelle Bompas, Pierre Biron, Jean‐Pierre Droz,

Ovarian cancer diagnosis and treatment

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Nov 2002Management of Post-Chemotherapy Residual Masses in Advanced Seminoma AUDE FLÉCHON, EMMANUELLE BOMPAS, PIERRE BIRON, and JEAN-PIERRE DROZ AUDE FLÉCHONAUDE FLÉCHON , EMMANUELLE BOMPASEMMANUELLE BOMPAS , PIERRE BIRONPIERRE BIRON , and JEAN-PIERRE DROZJEAN-PIERRE DROZ View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64275-9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We studied the resection of post-chemotherapy residual masses (20% to 80%) of advanced seminoma complicated by extensive fibrosis, in which active disease appears in 10% to 20% of cases. Materials and Methods: We retrospectively analyzed (1986 to 2000) residual mass evolution according to size in 79 platinum treated patients. Results: There was an evaluable response in 78 patients, including toxic death in 1 after 1 chemotherapy cycle, a complete response in 34 (after chemotherapy in 15 and after complete residual mass resection in 19), a marker negative partial response in 42 (incomplete residual mass resection in 8), stable and progressive disease in 1 each. In 15 of 31 patients the resected residual mass was 3 cm. or greater, whereas in 12 of 29 it was less than 3 cm. No surgery was performed for 3 residual masses of unknown size. Of the 42 residual masses 21 disappeared at a median of 12.5 months. Progression occurred at the initial tumor site in 11 of 13 patients after a median of 3.5 months, including 3 with a complete response, 8 with a marker negative partial response (residual mass 3 cm. or greater in 3, less than 3 cm. in 4 and unknown size in 1) and treatment failure in 2 (residual mass 3 cm. or greater). At a median followup of 36.4 months 67 patients survived (no disease progression in 56 and nonevolving residual masses in 11), while 12 had died including 9 of progressive disease 1 of toxicity and 2 of other causes. Conclusions: In our study there was incomplete surgical resection in 30% of cases. Relapse in 16.6% of cases occurred rapidly after the end of chemotherapy. Viable cells were only noted in residual masses 3 cm. or greater (13%) and 50% of residual masses disappeared during surveillance. We intend to perform a prospective cohort study with close followup of patients with residual masses less than 3 cm. using an indication for surgery tailored to positron emission tomography findings in those with residual masses 3 cm. or greater. References 1 International germ cell consensus classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Collaborative Group. J Clin Oncol1997; 15: 594. 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