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Liver metastases in germ cell cancer: defining a role for surgery after chemotherapy

Liver metastases in germ cell cancer: defining a role for surgery after chemotherapy
Liver metastases in germ cell cancer: defining a role for surgery after chemotherapy
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.
hepatic metastases, germ cell cancer, chemotherapy, surgery, outcome, survival
1464-410X
552-558
Copson, Ellen
a94cdbd6-f6e2-429d-a7c0-462c7da0e92b
McKendrick, Joe
5d105d42-a86b-46ad-93c6-1bea508edad5
Hennessey, Niklas
66228a5a-28d9-4f7e-9eb5-7b2d518adf5b
Tung, Ken
2219a90f-379d-44b5-9a6e-c2ee5871ce4a
Mead, Graham Z.
93cb1ced-acd7-4607-b2c1-c5575d9e5437
Copson, Ellen
a94cdbd6-f6e2-429d-a7c0-462c7da0e92b
McKendrick, Joe
5d105d42-a86b-46ad-93c6-1bea508edad5
Hennessey, Niklas
66228a5a-28d9-4f7e-9eb5-7b2d518adf5b
Tung, Ken
2219a90f-379d-44b5-9a6e-c2ee5871ce4a
Mead, Graham Z.
93cb1ced-acd7-4607-b2c1-c5575d9e5437

Copson, Ellen, McKendrick, Joe, Hennessey, Niklas, Tung, Ken and Mead, Graham Z. (2004) Liver metastases in germ cell cancer: defining a role for surgery after chemotherapy. BJU International, 94 (4), 552-558. (doi:10.1111/j.1464-410X.2004.04999.x).

Record type: Article

Abstract

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.

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More information

Published date: September 2004
Keywords: hepatic metastases, germ cell cancer, chemotherapy, surgery, outcome, survival

Identifiers

Local EPrints ID: 26255
URI: https://eprints.soton.ac.uk/id/eprint/26255
ISSN: 1464-410X
PURE UUID: 5f1e941a-9e8b-4521-bfc0-b94536c97281

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Date deposited: 19 Apr 2006
Last modified: 17 Jul 2017 16:08

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