284P - Clinical outcome of the treatment for residual masses after chemotherapy for metastatic germ cell tumors

Date 17 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Anti-Cancer Agents & Biologic Therapy
Germ Cell Tumours
Presenter Ryosuke Jikuya
Authors R. Jikuya1, A. Hashizume2, T. Tatenuma1, N. Mizuno3, K. Muraoka4, M. Kawai2, A. Takizawa4, T. Kishida1
  • 1Urology, Kanagawa Cancer Center, 241-8515 - Yokohama/JP
  • 2Urology, Kimitsu Chuo Hospital, 292-8535 - Chiba/JP
  • 3Urology, Yokohama Sakae Kyosai Hospital, 247-8581 - Yokohama/JP
  • 4Urology, International Goodwill Hospital, 245-0006 - Yokohama/JP

Abstract

Background

For advanced germ cell tumor (GCT), chemotherapy combined with resection of residual mass is recommended to achieve long term disease free survival. However, surgery for the residual mass was often difficult, and some cases were observed without surgery. The objective of this retrospective study was to assess the clinical outcome of metastatic germ cell tumor with residual mass after chemotherapy in our hospital.

Methods

From 1989 to 2016, 119 patients of metastatic germ cell tumor had been treated with chemotherapy. In this cohort, 72 patients who had residual tumors after chemotherapy were followed for up to 26 years (median; 64 months). Generally patients underwent chemotherapy until tumor marker became negative, then we followed our policy;

1) For seminoma, we observed residual masses irrespective of their size 2) For non-seminoma a) residual mass under 2cm were observed, b) residual mass over 5cm were performed extirpation, c) residual mass 2-5cm; extirpation were considered depending on the presence of teratoma component or rate of shrinkage after chemotherapy.

Results

Of 72 patients 16 were pure seminoma, 56 were nonseminoma and 18 were nonseminoma with teratoma. Twenty one were IGCCC good, 28 were intermediate and 23 were poor. After chemotherapy tumor marker was positive in 5 patients. Forty seven had residual tumors in retroperitoneal lymph node (RPLN), 2 in lung, 5 in mediastinum lymph node, 7 in RPLN and lung, 4 in other lesion. After chemotherapy 36 were observed, 24 underwent RPLND and 12 underwent other surgery. Six in 36 observed patient had relapses (17%). Among them, 3 patients died of disease but other 3 were treated with additional chemotherapy and were alive without disease. Pathological diagnosis of 36 patients who received surgery were cancer in 12, teratoma in 8 and no viable cell in 16. Nine in 36 who received surgery had relapse (25%). Among them, 4 were died of disease (1 with cancer, 1 with teratoma, 2 with no viable cell).

Conclusions

Our conservative policy resulted in long term disease specific survival. Although some patients may omit the residual mass resection, long term careful follow up will be necessary.

Clinical trial indentification