Surgical salvage of chemorefractory germ cell tumors.

TLDR

Chemorefractory disseminated germ cell tumors have a very poor prognosis, but a subset of patients have resectable disease. The study evaluated the role of salvage surgery in patients with chemorefractory but resectable germ cell tumors. A retrospective review of 48 patients with chemorefractory germ cell tumors who underwent various salvage surgeries (including 33 retroperitoneal lymph node dissections, six thoracotomies, and three thoracoabdominal resections) at Indiana University from 1977 to 1990 was performed. Salvage surgery rendered 79 % of patients grossly disease‑free and 60 % serologically remitted, with 21 % remaining disease‑free without additional therapy and an additional six patients achieving disease‑free status after further treatment, indicating a definite curative potential for selected patients.

Abstract

PURPOSE Patients with disseminated germ cell tumors who relapse after salvage chemotherapy, or who progress during cisplatin-based therapy, have chemorefractory disease and a very poor prognosis. A subset of these patients will have chemorefractory but resectable disease. We have therefore evaluated the role of salvage surgery in this patient population. PATIENTS AND METHODS We performed a retrospective review of all patients with disseminated germ cell tumors who were felt to have chemorefractory disease and underwent salvage surgery from 1977 to 1990 at Indiana University. All patients had elevated serum markers or other signs of progressive carcinoma. A total of 48 patients underwent surgery (33 retroperitoneal lymph node dissections [RPLNDs], six thoracotomies, three thoracoabdominal resections, and multiple asynchronous procedures in six patients). RESULTS Thirty-eight of 48 patients (79%) were rendered grossly free of disease and 29 (60%) obtained a serologic remission. Ten patients (21%) remain continuously disease-free with no postoperative treatment with a median follow-up of 46 months (range, 31 to 89). Six additional patients who relapsed after salvage surgery are currently disease-free with further treatment (four with repeat surgery and two with high-dose chemotherapy and autologous bone marrow transplantation [ABMT]). CONCLUSION Selected patients with chemorefractory but resectable germ cell tumors have definite potential for cure with salvage surgery.