Desperation Postchemotherapy Retroperitoneal Lymph Node Dissection for Metastatic Germ Cell Tumors




Key points








  • Patients with persistently elevated serum tumor markers should be monitored for marker kinetics and evaluated for nonviable cancer causes of marker elevation.



  • Desperation postchemotherapy retroperitoneal lymph node dissection is performed in select patients following second-line chemotherapy.



  • Adjuvant postoperative chemotherapy is not indicated in patients following second-line chemotherapy.






Introduction


Patients with advanced germ cell tumors (GCTs) of the testis (cIIB–cIII) and those with persistently elevated serum tumor markers (STM) following radical orchiectomy (cIS) are initially treated with platinum-based chemotherapy according to the International Germ Cell Cancer Collaborative Group risk classification. Approximately 70% to 80% are rendered free of disease following first-line chemotherapy and adjunctive resection of all residual sites of disease. Despite the profound sensitivity of GCTs to platinum-based chemotherapy regimens, approximately 20% to 30% of patients will not achieve undetectable STMs following first-line risk-appropriate chemotherapy or will relapse early following a serologic complete response. With rare exception, these patients are managed with conventional second-line chemotherapy regimens or high-dose chemotherapy with autologous stem cell replacement. With this approach, approximately 50% to 60% of patients will achieve a complete clinical response and long-term freedom from relapse following surgical resection of all sites of residual disease. However, a subset of patients will continue to have persistently elevated STMs and proceed directly to surgical resection, known as a desperation postchemotherapy retroperitoneal lymph node dissection (PC-RPLND), or third-line systemic therapies. In the current article, the indications for and therapeutic outcomes following PC-RPLND and resection of extra-retroperitoneal sites of disease in patients with persistently elevated STMs following chemotherapy are reviewed.

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Mar 3, 2017 | Posted by in UROLOGY | Comments Off on Desperation Postchemotherapy Retroperitoneal Lymph Node Dissection for Metastatic Germ Cell Tumors

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