Nonseminomatous germ cell testicular tumors clinical stage II: Retroperitoneal lymph node dissection, chemotherapy or both?

Abstract

4746 Background: Patients (pts) with nonseminomatous germ cell testicular tumors (NSGCTT) clinical stage IIa and IIb can be treated with: retroperitoneal lymph node dissection (RPLND), RPLND followed by adjuvant chemotherapy (CT) or CT with surgery of residual masses. The optimal management for is still debated. Methods: We analyzed retrospectively 55 pts with NSGCTT clinical stage IIa (28) and IIb (27) followed in our Institutions. Median age was 29 (17–55) years. Embrional carcinoma (EC) was predominant in 40 (73%) pts. Serum tumor markers were elevated in 58% of the pts. Treatment was: RPLND in 7 IIa (3 resulted a I pathological stage) and in 2 IIb pts; RPLND and adjuvant CT (2 or 3 cycles of platinum based CT) in 12 IIa and in 5 IIb pts; CT alone (mainly 3 PEB) in 3 IIa and in 10 IIb pts; CT followed by RPLND for residual masses in 6 IIa and in 10 IIb. Median follow-up was 70 (5–202) months. Results: Relapses occurred in 3 pts (5%): all of them were IIb and with predominance of EC. Median time to relapse was 7 months (4–9); site of relapse were: retrocrural lymph nodes, lung and serum tumor marker only respectively. Two were initially treated with RPLND alone and at relapse platinum-based chemotherapy: both are alive and free from disease. One pt, treated at the beginning with RPLND and adjuvant CT (3 PEB), relapsed and despite any treatment died of disease. Conclusions: i) The preferred initial treatment was RPLND in pts with stage IIa and chemotherapy in pts with stage IIb; ii) false positive staging error was 16% in clinical stage IIa; iii) relapse can occur, particularly in pts with IIb (11%) and EC predominance (7.5%), quite soon and in different sites; iv) no one pts treated primarily with 3 PEB relapsed; v) more than 98% ot the pts are alive and disease-free irrespectively of treatment option: histology, clinical stage and patient's preferences should be part of the decision making. No significant financial relationships to disclose.