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Residual Tumor Resection After High-Dose Chemotherapy in Patients With Relapsed or Refractory Germ Cell Cancer

From the Department of Hematology and Oncology, Charité, Campus Mitte; Department of Urology, Krankenhaus Am Urban, Berlin; Department of Hematology and Oncology, Eberhards-Karl Universität, Tübingen; Department of Thoracic Surgery, Dr-Horst-Schmidt Kliniken, Wiesbaden; Department of Urology, Bundeswehrkrankenhaus, Hamburg; and Department of Hematology and Oncology, Philipps Universität, Marburg, Germany

Address reprint requests to J. Beyer, MD, Department of Hematology and Oncology, Philipps Universität Marburg, Baldinger Strasse, 35033 Marburg, Germany; e-mail: joerg.beyer{at}mailer.uni-marburg.de

PURPOSE: To assess the role of residual tumor resection performed after high-dose chemotherapy (HDCT) in patients with relapsed or refractory germ cell tumors (GCT).

PATIENTS AND METHODS: Between July 1987 and October 1999, postchemotherapy resections of residual tumors were performed in 57 patients who had been treated with HDCT for relapsed or refractory GCT and who had achieved a partial remission to this treatment.

RESULTS: Complete resections of residual masses were achieved in 52 (91%) of 57 patients who were rendered disease free; in five (9%) of 57 patients, the resections were incomplete. Resection of a single site was performed in 39 (68%) of 57 patients, and the remaining 18 (32%) of 57 patients required interventions at two or more residual tumor sites. Necrosis was found in 22 (38%) of 57 patients, mature teratoma with or without necrosis was found in nine (16%) of 57 patients, and viable cancer with or without additional necrosis or mature teratoma was found in 26 (46%) of 57 patients. Viable cancer consisted either of residual germ cell or undifferentiated cancer in 22 (85%) of 26 patients, with additional non-GCT histologies in the remaining four patients. Patients with viable cancer had a significantly inferior outcome after surgery compared with patients with necrosis and/or mature teratoma even if all cancer was completely resected. Pulmonary lesions with a diameter of more than 2 cm were the only predictive variable for viable cancer in univariate analysis.

CONCLUSION: Resections of all residual tumors should be attempted in patients with relapsed or refractory GCT and partial remissions after HDCT.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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