Complete disappearance of retroperitoneal lymph nodes after induction chemotherapy in advanced nonseminomatous germ cell tumors (NSGCT): Is there a place for adjunctive surgery?

Abstract

e15029 Background: The management of patients (pts) with a radiographic complete disappearance of retroperitoneal lymph nodes (CD-RPLN) metastases after chemotherapy (CT) remains controversial. Some authors recommend post-CT retroperitoneal lymph node dissection (PC-RPLND), whereas others omit surgery and observe these pts. In this retrospective study we analyzed outcome of pts with advanced NSGCT who achieved CD-RPLN and did not undergo PC-RPLND. Methods: From 1988 to 2008, 886 CT-naïve pts with advanced NSGCT were treated in our department with first-line cisplatin- and etoposide-based CT. All residual tumors >1cm were resected when it was feasible. Pts who had CD-RPLN (≤1cm by CT-scan) and normalized tumor markers after CT were included into the study. Results: One hundred thirty seven pts were identified. 30% pts had teratoma in primary tumor. Following CT 13 pts underwent resection of extra-retroperitoneal lesions, no viable carcinoma was found. Good, intermediate and poor IGCCCG prognosis had 87 (64%), 33 (24%) and 17 (12%) pts, respectively. After a median f.-up of 72 (6-193) months, 11 (8%) pts relapsed. All but one relapses occurred in the first two years. Only 4 (3%) relapses developed in RPLN and were treated with salvage CT and surgery, all 4 pts died. Relapse rate in RPLN was equal among prognostic groups (good 2(2%), intermediate 1(3%), poor 1(6%) pts). 5-years OS were 94%, 97% and 79%, respectively. Conclusions: Pts obtaining complete disappearance of RPLN after induction CT had low risk of relapse and can be safely observed without surgery.