Eggener SE et al. (2007) Pathologic findings and clinical outcome of patients undergoing retroperitoneal lymph node dissection after multiple chemotherapy regimens for metastatic testicular germ cell tumors. Cancer 109: 528–535

Although 20–30% of men with testicular cancer experience tumor progression or recurrence after first-line chemotherapy, 35–70% of these patients will respond to salvage chemotherapy. Postchemotherapy resection of residual disease following multiple chemotherapy regimens remains, however, an important component of treatment for men with advanced testicular cancer.

Eggener and colleagues evaluated 71 men with testicular cancer who underwent two or more chemotherapy regimens followed by retroperitoneal lymph-node dissection (RPLND) to resect all known residual masses. These patients were followed for a median of 30 months (52 months for survivors), and the 5-year and 10-year disease-specific survival rates were 74% and 70%, respectively. Almost half of the patients had either viable germ-cell tumor or teratoma at RPLND, but those who received taxane-based salvage chemotherapy regimens had a decreased rate of viable germ-cell tumor (14% versus 42%). Retroperitoneal and extraperitoneal histology were discordant in 25% of cases, which emphasized the need for resection of all residual masses.

Eggener and colleagues recommend postchemotherapy surgery for selected patients with advanced germ-cell tumors: RPLND for those who respond to salvage chemotherapy and lack radiologically visible residual disease; RPLND with extraperitoneal resection for patients who respond to chemotherapy and have resectable residual masses. Some patients with residual masses and elevated serum tumor markers might also benefit from postchemotherapy surgery.