The Experience of Combination of Chemotherapy and Surgery in Treatment of Advanced Nonseminomatous Germ Cell Tumor of the Testis

Abstract

Cisplatin-based chemotherapy is highly effctive in treating germ cell tumors. Inductive chemotherapy and postchemotherapy retroperitoneal lymph node dissection (RPLND) have become the prefered standard treatment in advanced nonseminomatous germ cell tumor of the testis. Ten patients with advanced nonseminomatous germ cell tumor were treated with cisplatin-based chemotherapy. Four cycles BEP (bleomycin plus etoposide plus cisplatin) or EP (etoposide plus cisplatin) chemotherapy yielded 70% complete remission rate in advanced nonseminomatuos germ cell tumor of the testis. Six of these patients underwent RPLND and simultaneous resection of the postchemotherapy residual masses. The histologic findings of resected residual masses were necrosis/fibrosis in 2 (33%) patients, mature teratoma in 1 (17%) patient, and viable tumor in 3 (50%) patients. Patients with viable tumors received additional cycles of chemotherapy. These 6 patients had no evidence of disease after a mean follow-up time of 72 mo. The other 4 patients who were refractory to inductive chemotherapy (n=3) or afraid of surgery (n=1) all died of the disease within 2 yrs. BEP chemotherapy is effective as first-line inductive treatment in advanced nonseminoma-tous germ cell tumors, and the toxicity is easily manageable. Postchemotherapy retroperitoneal lymph node dissection with resection of residual masses is mandatory and can foster long-term disease-free survival.