Commentary: Good news travels fast

Abstract

Central MessageMetastatic germ cell tumors have high cure rates with cisplatin chemotherapy followed by surgery. Although teratoma is the most common pathology, other benign and malignant elements can be present.See Article page 856. Metastatic germ cell tumors have high cure rates with cisplatin chemotherapy followed by surgery. Although teratoma is the most common pathology, other benign and malignant elements can be present. See Article page 856. Before the results of a phase II trial demonstrating the effectiveness of cisplatin-based chemotherapy for disseminated testicular cancer were published in 1976, the word was out and survival rates began to exponentially increase for a malignancy, which at the time was rarely cured.1Feuer E.J. Kessler L.G. Baker S.G. Triolo H.E. Green D.T. The impact of breakthrough clinical trials on survival in population based tumor registries.J Clin Epidemiol. 1991; 44: 141-153Abstract Full Text PDF PubMed Scopus (37) Google Scholar,2Einhorn L.H. Furnas B.E. Powell N. Combination chemotherapy of disseminated testicular carcinoma with cis-platinum, diamine dichloride (CPDD), vinblastine, (VBL) and bleomycin (BLEO).Proc AACR-ASCO. 1976; 17 (abstr): 240Google Scholar The treatment algorithm of combination chemotherapy followed by aggressive surgery to remove residual disease for metastatic nonseminomatous germ cell tumors is now considered one of most successful models for multimodality cancer therapy, which our thoracic oncology community emulates for other locally advanced neoplasms with improved but currently lesser success. Although cure rates for testicular cancer are very high, there still remain frontiers for improvement, such as the quandary of chemorefractory nonseminomatous cancer and malignant (somatic) transformation (fortunately representing only a minority of cases) and the variety of postchemotherapy pathology, which has implications for the indications to remove residual disease. For 2 examples, avoidance of pulmonary metastasectomy would seem prudent where there is a high likelihood of complete tumor necrosis. In contrast, pulmonary metastasectomy for numerous areas of chemorefractory disease may be futile. Donahoe and coworkers3Donahoe L.L. Nason G.J. Bedard P.L. Hansen A.R. Jewett M.A. Hamilton R.J. et al.Pathologic concordance of resected metastatic nonseminomatous germ cell tumors in the chest.J Thorac Cardiovasc Surg. 2021; 161: 856-868.e1Abstract Full Text Full Text PDF Scopus (3) Google Scholar have taken a deep dive into their institutional experience, examining the pathology and survival outcomes after surgery for nonseminomatous testicular cancer metastatic to the lung and mediastinum. The authors' messages are important. First, the ability to predict postchemotherapy pathology is overall good, taking under consideration serum tumor marker levels, computed tomography appearance, and orchiectomy pathology, but the predictive accuracy as well as the concordance between lung, mediastinum, and retroperitoneal pathology remains imperfect. Second, while “benign” teratoma is the most common pathology in residual abnormalities following chemotherapy, there can be a variety of other benign and malignant elements. In this regard, this manuscript also serves to educate on the spectrum of pathology that can be encountered. Finally, careful, long-term surveillance after surgery, with removal of recurrent disease when appropriate, is necessary to maintain optimal outcomes. The Toronto group has established a center of excellence with expert medical oncologists, urologic, and thoracic surgeons for a multidisciplinary approach to nonseminomatous germ cell cancers. This multidisciplinary approach optimizes outcomes for these otherwise-young and healthy patients and is particularly important for the challenging patients with chemorefractory disease. Donahoe and colleagues are to be congratulated on an excellent study that helps define the management of disseminated testicular cancer. Pathologic concordance of resected metastatic nonseminomatous germ cell tumors in the chestThe Journal of Thoracic and Cardiovascular SurgeryVol. 161Issue 3PreviewMen with metastatic nonseminomatous germ cell tumors (NSGCTs) often present with residual chest tumors after chemotherapy. We examined the pathologic concordance of intrathoracic disease and outcomes based on the worst pathology of disease resected at first thoracic surgery. Full-Text PDF