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Liver metastases in germ cell cancer: defining a role for surgery after chemotherapy
Author(s) -
Copson Ellen,
McKendrick Joe,
Hennessey Niklas,
Tung Ken,
Mead Graham Z.
Publication year - 2004
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 - 10.1111/j.1464-410x.2004.04999.x
Subject(s) - medicine , germ cell tumors , chemotherapy , cancer , radiological weapon , liver cancer , germ cell , radiology , surgery , oncology , biochemistry , chemistry , gene
OBJECTIVE To review the clinical course and outcome of patients with germ cell cancer and liver metastases treated at one centre, as the presence of hepatic metastases, although rare, is a poor prognostic feature in germ cell cancer. PATIENTS AND METHODS The case records of all patients with germ cell cancer and liver metastases at presentation, and treated with chemotherapy at a medical oncology unit between 1984 and 2001, were reviewed. The treatment regimens, tumour responses and patient outcome were recorded. RESULTS Twenty‐seven patients with germ cell cancer metastatic to the liver were identified. Complete biochemical and radiological responses were achieved in eight patients after initial chemotherapy and surgery for non‐hepatic residual disease. Seven patients had only residual radiological hepatic abnormalities with normal tumour markers at the completion of initial treatment. There were no immediate hepatic resections and no further therapy was given. Serial computed tomography (CT) confirmed a progressive reduction in the size of hepatic lesions in six of seven patients. The persistence of residual hepatic abnormalities was not predictive of relapse, and overall survival of these patients (median survival 49 months, range 15–120) compared well with recent reports of such patients who have undergone hepatic resection. CONCLUSIONS Conservative management with regular assessment by CT is an acceptable alternative to immediate hepatic resection for patients with isolated residual radiological hepatic abnormalities on completing first‐line therapy for metastatic germ cell cancer, and does not adversely affect their survival.