The purpose of this review is to educate medical oncologists on the management of patients with residual germ cell tumors and the role of surgical resection after platinum-based chemotherapy.
Patients with non-seminomatous testicular cancer and residual enlarged retroperitoneal lymph nodes > 1 cm following induction chemotherapy with normal tumor markers should undergo a post-chemotherapy retroperitoneal lymph node dissection. All patients with primary mediastinal non-seminoma should undergo surgical resection of the mediastinal mass post-chemotherapy. These are complex surgeries and require expert surgeons in high-volume centers. Patients with advanced testicular seminoma who have residual masses less than 3 cm after chemotherapy can be observed without further intervention. Patients with a residual mass > 3 cm should be evaluated with PET scan after 6 weeks of chemotherapy. Residual mass with negative PET scan can be followed by surveillance while a positive PET scan requires further work up to rule out active disease.
Current oncology reports. 2019 Jan 21*** epublish ***
Costantine Albany, Kenneth Kesler, Clint Cary
Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr. RT 473, Indianapolis, IN, 46202, USA. ., Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr EH 212, Indianapolis, IN, 46202, USA., Department of Urology, Indiana University School of Medicine, 535 Barnhill Dr., Indianapolis, IN, 46202, USA.