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Postchemotherapy retroperitoneal lymph node dissection is effective therapy in selected patients with elevated tumor markers after primary chemotherapy alone.
Urology. 1997 Dec; 50(6):957-62.U

Abstract

OBJECTIVES

Elevated tumor markers after primary chemotherapy for metastatic testis cancer are usually an indication of persistent cancer. Subsequent treatment has usually been salvage chemotherapy. This article examines the possibility that selected patients can achieve long-term disease-free survival with surgery alone.

METHODS

Using a computerized data base of 627 postinduction chemotherapy retroperitoneal lymph node dissections (PC-RPLND), 23 patients with elevated tumor markers who have undergone PC-RPLND after induction chemotherapy alone were identified. Of the 23 patients, 15 were considered candidates for salvage chemotherapy, but instead underwent salvage surgery. Case histories were reviewed to establish selection criteria for PC-RPLND.

RESULTS

Eight patients originally presented as clinical Stage C, 6 as clinical Stage B-3, and 1 as clinical Stage B-2. All patients initially received cisplatin combination chemotherapy. Twelve patients had an elevated alpha-fetoprotein level and 3 patients had an elevated beta human chorionic gonadotropin level prior to PC-RPLND. Seven patients had rising markers at the time of PC-RPLND. Seven patients had teratoma only in their resected specimen and all have no evidence of disease (NED) at a median of 35 months. Two patients had necrosis only in their RPLND specimen and both are NED at 10 and 42 months. Six patients had cancer in their resected specimen and 2 are NED, 1 is alive with disease, and 3 are dead of disease. Five of the 6 patients with cancer in their resected specimen were the only patients who received postoperative chemotherapy.

CONCLUSIONS

Some patients with modest elevations of tumor markers after induction chemotherapy may only have teratoma or necrosis in the postchemotherapy resected specimen. These patients (n = 9) remain continuously NED. Patients who undergo salvage surgery and have cancer in the resected specimen do less well, but selected patients can be cured with this modality and thus avoid the morbidity of salvage chemotherapy.

Authors+Show Affiliations

Department of Urology, Indiana University Medical Center, Indianapolis 46202, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9426730

Citation

Coogan, C L., et al. "Postchemotherapy Retroperitoneal Lymph Node Dissection Is Effective Therapy in Selected Patients With Elevated Tumor Markers After Primary Chemotherapy Alone." Urology, vol. 50, no. 6, 1997, pp. 957-62.
Coogan CL, Foster RS, Rowland RG, et al. Postchemotherapy retroperitoneal lymph node dissection is effective therapy in selected patients with elevated tumor markers after primary chemotherapy alone. Urology. 1997;50(6):957-62.
Coogan, C. L., Foster, R. S., Rowland, R. G., Bihrle, R., Smith, E. R., Einhorn, L. H., Roth, B. J., & Donohue, J. P. (1997). Postchemotherapy retroperitoneal lymph node dissection is effective therapy in selected patients with elevated tumor markers after primary chemotherapy alone. Urology, 50(6), 957-62.
Coogan CL, et al. Postchemotherapy Retroperitoneal Lymph Node Dissection Is Effective Therapy in Selected Patients With Elevated Tumor Markers After Primary Chemotherapy Alone. Urology. 1997;50(6):957-62. PubMed PMID: 9426730.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postchemotherapy retroperitoneal lymph node dissection is effective therapy in selected patients with elevated tumor markers after primary chemotherapy alone. AU - Coogan,C L, AU - Foster,R S, AU - Rowland,R G, AU - Bihrle,R, AU - Smith,E R,Jr AU - Einhorn,L H, AU - Roth,B J, AU - Donohue,J P, PY - 1998/1/14/pubmed PY - 2001/3/28/medline PY - 1998/1/14/entrez SP - 957 EP - 62 JF - Urology JO - Urology VL - 50 IS - 6 N2 - OBJECTIVES: Elevated tumor markers after primary chemotherapy for metastatic testis cancer are usually an indication of persistent cancer. Subsequent treatment has usually been salvage chemotherapy. This article examines the possibility that selected patients can achieve long-term disease-free survival with surgery alone. METHODS: Using a computerized data base of 627 postinduction chemotherapy retroperitoneal lymph node dissections (PC-RPLND), 23 patients with elevated tumor markers who have undergone PC-RPLND after induction chemotherapy alone were identified. Of the 23 patients, 15 were considered candidates for salvage chemotherapy, but instead underwent salvage surgery. Case histories were reviewed to establish selection criteria for PC-RPLND. RESULTS: Eight patients originally presented as clinical Stage C, 6 as clinical Stage B-3, and 1 as clinical Stage B-2. All patients initially received cisplatin combination chemotherapy. Twelve patients had an elevated alpha-fetoprotein level and 3 patients had an elevated beta human chorionic gonadotropin level prior to PC-RPLND. Seven patients had rising markers at the time of PC-RPLND. Seven patients had teratoma only in their resected specimen and all have no evidence of disease (NED) at a median of 35 months. Two patients had necrosis only in their RPLND specimen and both are NED at 10 and 42 months. Six patients had cancer in their resected specimen and 2 are NED, 1 is alive with disease, and 3 are dead of disease. Five of the 6 patients with cancer in their resected specimen were the only patients who received postoperative chemotherapy. CONCLUSIONS: Some patients with modest elevations of tumor markers after induction chemotherapy may only have teratoma or necrosis in the postchemotherapy resected specimen. These patients (n = 9) remain continuously NED. Patients who undergo salvage surgery and have cancer in the resected specimen do less well, but selected patients can be cured with this modality and thus avoid the morbidity of salvage chemotherapy. SN - 0090-4295 UR - https://www.unboundmedicine.com/medline/citation/9426730/Postchemotherapy_retroperitoneal_lymph_node_dissection_is_effective_therapy_in_selected_patients_with_elevated_tumor_markers_after_primary_chemotherapy_alone_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-4295(97)00458-5 DB - PRIME DP - Unbound Medicine ER -