Post-chemotherapy retroperitoneal resection of residual masses testicular cancer

Thursday, 13 March 2008 - Prof. Axel Heidenreich presented the results of his team that examined post-chemotherapy  retroperitoneal resection of residual masses with a modified template resection during the  2008 Genitourinary Cancers Symposium held under the auspices of the American Society of Oncology in San Francisco, USA.

Residual tumour resection (RTR) following inductive chemotherapy for metastatic germ cell tumours (GCT) is an integral part of the multimodality approach. According to Heidenreich, there is still controversial debate whether retroperitoneal RTR should be performed as full bilateral template or as modified unilateral template. The purpose of the study was to assess the oncological necessity of full bilateral retroperitoneal RTR.

Following inductive chemotherapy 155 patients with primary advanced nonseminomatous germ cell tumour (NSGCT) underwent retroperitoneal RTR with all patients showing normalization or plateauing of previously elevated serum tumour markers. Depending on the size and the location of the residual mass or the location of the primary testicular tumour, a full bilateral template resection (n = 51) or a modified template resection (n = 104) was performed.

In their results, the investigators said 89 patients (57.4%) had necrosis/fibrosis, 45 (29%) and 23 (14.8%) patients had mature teratoma and vital cancer in the RTR specimens, respectively, 83 (53.5%) patients were of good risk, and 38 (24.5%) and 31 (20%) patients had intermediate- and poor-risk characteristics, respectively. Mean tumour size was 5.9 cm (0.5-30); the mean tumour size in radical and modified RTR was different, 10.3 cm and 4.1 cm, respectively. There was a significant difference in postoperative morbidity between bilateral and modified RTR with more complications for extended surgery (p < 0.001).

Moreover, antegrade ejaculation was preserved in 85% and 25% of patients undergoing bilateral and modified RTR (p = 0.02), respectively. “We observed 8 (5.1%) recurrences after a mean follow-up of 39 (2-84) months: 1 in-field relapse following modified RTR and 7 recurrences outside the boundaries of full bilateral RTR,” according to Heidenreich.
 Two-year disease free survival was 65% and 91% for bilateral and modified RTR, respectively.

In their conclusions, the authors said full bilateral RTR should be considered as the surgical approach of choice in patients with extensive residual masses, interaortacaval location, or a site location of the residual mass not corresponding to the site of the primary testis tumour. The investigators also noted that in well-defined small masses less than 5 cm, a modified template RTR does not interfere with oncological outcome but decreases treatment associated morbidity.

Source: A. Heidenreich, ‘Post-chemotherapy retroperitoneal resection of residual masses in germ cell cancer with modified template resection, Abstract Session, First Genitourinary Cancers Symposium, ASCO, San Francisco, California, 16 February 2008

By: Joel Vega

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