Long-Term Clinical Outcome After Postchemotherapy Retroperitoneal Lymph Node Dissection In Men With Residual Teratoma

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 19 Feb 2007 - 10:00 PDT

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UroToday.com- Patient with residual masses after chemotherapy for mixed germ cell tumors should undergo retroperitoneal lymphadenectomy to address the measurable incidence of teratoma (40%) and viable cancer in the retroperitoneum. The long-term pattern of recurrence and recommended surveillance strategy of these patients has not been well defined.

In the January 29th issue of the Journal of Clinical Oncology, Carver, Sheinfeld and colleagues from Memorial Sloan-Kettering report their extensive experience with patients with residual teratoma after post-chemotherapy RPLND. Over a period of 14 years, 210 patients with mixed germ cell tumors underwent post-chemotherapy RPLND and were found to have only teratoma in the resected specimen. Only 9% of patients had received salvage chemotherapy.

Pathology consisted of mature teratoma in 85%, immature teratoma in 7%, and teratoma with malignant degeneration in 8% of patients. The overall recurrence rate was 14.2% after a median follow-up of 37 months. Of these 30 patients, one-third recurred with teratoma, 17% teratoma with malignant transformation, and half with immature teratoma.

The probability of being recurrence-free after 5 and 10 years was 83% and 80%, respectively. Patients with large masses (> 5 cm). and/or an elevated International Germ Cell Cancer Collaborative Group (IGCCCG) classification risk exhibited the highest risk of recurrence.

Patients with residual teratoma after postchemotherapy RPLND continue to exhibit a 20% risk of recurrence even 10 years after surgery, with 67% of recurrences being immature teratoma or teratoma with malignant transformation. These data suggest that these patients should undergo long-term surveillance of their retroperitoneum especially in the setting of a large postchemotherapy mass or an elevated IGCCCG classification risk.

Brett S. Carver, Bobby Shayegan, Angel Serio, Robert J. Motzer, George J. Bosl, Joel Sheinfeld
J Clin Oncol. 2007 Jan 29; [Epub ahead of print]

Reviewed by UroToday.com Contributing Editor Ricardo F. Sánchez-Ortiz, MD

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