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The management of residual masses after chemotherapy in metastatic seminoma
Author(s) -
Ravi Ravi,
Duu Sheng Ong,
; Oliver,
Badenoch,
Fowler,
Hendry Hendry
Publication year - 1999
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.1999.00974.x
Subject(s) - seminoma , medicine , chemotherapy , histology , residual , radiology , surgery , stage (stratigraphy) , algorithm , computer science , paleontology , biology
Objective To review our experience in management of residual masses after chemotherapy for metastatic seminoma. Patients and methods The study comprised a review of 107 patients with metastatic seminoma, treated with initial chemotherapy from 1978 to 1996. Forty‐three patients had residual masses detected by computed tomography after chemotherapy, while 64 achieved a complete response. Residual masses were classified radiologically as <3 cm or ≥3 cm and as well‐ or poorly defined. Of the patients with residual masses, 19 underwent surgery, while 24 were observed. Results Viable cancer was present in six of 11 patients with well‐defined residual masses of ≥3 cm (positive histology in three of six undergoing surgery and site relapses in three of five observed), one of 14 patients with poorly defined masses of ≥3 cm (negative histology in nine undergoing surgery and site relapse in one of five observed), and in none of 17 patients with residual masses of <3 cm (negative histology in four undergoing surgery and no site relapses in 13 observed; one additional patient in this group died from treatment complications). Conclusion Patients with a complete response after chemotherapy, a residual mass of <3 cm and a poorly defined residual mass of ≥3 cm can be observed, reserving intervention for recurrent or progressive disease. Well‐defined residual masses of ≥3 cm should be resected because there is a 55% likelihood of persistent tumour.