RESULTS OF POSTHEMOTHERAPY RETROPERITONEAL SURGERY IN PATIENTS WITH NONSEMINOMATOUS TESTICULAR CANCER AND RESIDUAL TUMOR MASSES

Thirty-six patients with nonseminomatous germ cell tumors (NSGCT), whose metastatic lesions were evaluable for response after chemotherapy (CT), were retrospectively reviewed. Histology was embryonal carcinoma in 13, teratocarcinoma in 11, combined germ cell tumor in 9, mixed seminoma and embryonal carcinoma in 2 and endodermal sinus tumor in one patient. Four patients had stage IIa, 8 IIb, 18 IIIc and 6 IV disease; a total of 33 paraaortic, 4 iliac, one mediastinal and one pulmonary masses were evaluable for response after 4 cycles of CT. Nine patients had complete and 27 had partial radiological response (PR). Of those with PR, two patients with residual masses less than 2 cm were followed without adjunctive surgery, one refused surgery, two had financial problems preventing surgery and one was deemed unresectable on computerized tomography. Biopsy of the unresectable mass revealed viable NSGCT. Residual masses were resected in 21 patients. Pathological examination revealed mature teratoma in 11 (50%) and viable NSGCT in 4 (18.2%) patients. Adjunctive surgery provides a pathological evaluation of response to CT, better prediction of prognosis, as well as surgical treatment of teratoma and salvage of viable NSGCT resistant to CT.