Abstract
4601 Background: Residual tumor resections (RTR) after salvage chemotherapy are of utmost importance due to a much higher rate of vital carcinoma in the residual tumor. A complete RTR may lead to an improved long term survival of such patients (pts). Methods: A retrospective analysis was performed in 197 pts who underwent 209 RTRs in 2 referral centers (2003-2011) with identical surgical technique (2 surgeons). The RTR database was queried for pts who received salvage chemotherapy (conventional salvage chemotherapy (CCT) or high-dose salvage chemotherapy (HDCT)) and a subsequent RTR. Results: Sixty (29%) of all RTRs were performed after salvage chemotherapy. In 31 pts (52%) and 29 pts (48%) a CCT and HDCT was used as salvage regimen, respectively.Vital cancer was found in 48% and 45% of pts with CCT and HDCT. Respectively, vital cancer consisted of germ cell cancer and malignant transformed teratoma in 61% and 39% of the cases. In contrast, the percentage of vital cancer in pts after 1st-line treatment was 30% (p= 0.0365).This comparatively high rate is due to a 55% rate of intermediate/poor prognosis pts in the whole group of 209 RTRs. To date we have evaluated the oncological outcome in 171 of 197 pts with a median follow-up of 23 months (1-227). In 142 pts no relapse was observed, whereas in 29 pts a GCT relapse occured (17%), 7 (4.6%) of all evaluated pts had an “in-field”-relapse. 7 pts died due to tumor progression. The relapse rate in pts with RTR after salvage regime was significantly higher compared to RTR pts after primary chemotherapy (37% vs. 13%, p= 0.0008). The „in-field“-relapse rate in pts with RTR after salvage was only in 3.9%, 2 pts died due to tumor progression. Conclusions: Every second pts with RTR after salvage chemotherapy showed vital cancer in the residual tumor. The relapse rate in pts with RTR after salvage chemotherapy was significantly higher compared to RTR pts after first-line chemotherapy (p=0.0008) but the “infield” relapse rate was similar. A complete resection of all residual lesions after salvage chemotherapy is necessary to potentially improve the long-term disease-free survival. This is especially true for pts with malignant transformed teratoma and restricted options for repeated salvage chemotherapy.
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