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Orchidectomy after chemotherapy for patients with metastatic testicular germ cell cancer

Orchidectomy after chemotherapy for patients with metastatic testicular germ cell cancer
Orchidectomy after chemotherapy for patients with metastatic testicular germ cell cancer
Objective: to evaluate the contribution of routine orchidectomy in the management of patients who present with advanced, metastatic, testicular germ cell cancer and who are treated with initial chemotherapy.
Patients and methods: sixty consecutive patients presenting with metastatic testicular germ cell cancer and treated with initial chemotherapy followed by orchidectomy were identified. The results from a clinical and pathological review of these patients are presented. The pathological findings at orchidectomy were compared with the pathological findings from metastatic masses resected after chemotherapy, and are reviewed with the clinical outcome.
Results: of the 60 orchidectomy specimens after chemotherapy, 24 (40%) contained significant histological abnormalities comprising residual invasive germ cell cancer, intratubular germ cell neoplasia and/or mature teratoma. The remaining 36 (60%) orchidectomy specimens contained fibrous scarring with or with no necrosis. Six (10%) orchidectomy specimens contained residual invasive germ cell cancer, three nonseminomatous germ cell cancer (NSGCT) and three seminoma. The patients with residual invasive NSGCT present within the testis had evidence of residual invasive NSGCT within extragonadal masses resected after chemotherapy; all three have relapsed and died from chemorefractory progressive disease.
Conclusion: orchidectomy after chemotherapy is recommended in all patients undergoing primary chemotherapy, as a significant proportion (40%) are left with histological abnormalities that predispose to subsequent relapse. Persistence of invasive NSGCT at the site of the primary tumour after chemotherapy is associated with persistence of invasive disease at other metastatic sites and is a poor prognostic finding.
1464-4096
451-455
Geldart, T.R.
b8a413b9-fe62-4010-8146-dfbb86f38b52
Simmonds, P.D.
27d4c068-e352-4cbf-9899-771893788ade
Mead, G.M.
8a97f978-9c66-4a16-bb03-dd83d20b06a0
Geldart, T.R.
b8a413b9-fe62-4010-8146-dfbb86f38b52
Simmonds, P.D.
27d4c068-e352-4cbf-9899-771893788ade
Mead, G.M.
8a97f978-9c66-4a16-bb03-dd83d20b06a0

Geldart, T.R., Simmonds, P.D. and Mead, G.M. (2002) Orchidectomy after chemotherapy for patients with metastatic testicular germ cell cancer. BJU International, 90 (4), 451-455. (doi:10.1046/j.1464-410X.2002.02916.x).

Record type: Article

Abstract

Objective: to evaluate the contribution of routine orchidectomy in the management of patients who present with advanced, metastatic, testicular germ cell cancer and who are treated with initial chemotherapy.
Patients and methods: sixty consecutive patients presenting with metastatic testicular germ cell cancer and treated with initial chemotherapy followed by orchidectomy were identified. The results from a clinical and pathological review of these patients are presented. The pathological findings at orchidectomy were compared with the pathological findings from metastatic masses resected after chemotherapy, and are reviewed with the clinical outcome.
Results: of the 60 orchidectomy specimens after chemotherapy, 24 (40%) contained significant histological abnormalities comprising residual invasive germ cell cancer, intratubular germ cell neoplasia and/or mature teratoma. The remaining 36 (60%) orchidectomy specimens contained fibrous scarring with or with no necrosis. Six (10%) orchidectomy specimens contained residual invasive germ cell cancer, three nonseminomatous germ cell cancer (NSGCT) and three seminoma. The patients with residual invasive NSGCT present within the testis had evidence of residual invasive NSGCT within extragonadal masses resected after chemotherapy; all three have relapsed and died from chemorefractory progressive disease.
Conclusion: orchidectomy after chemotherapy is recommended in all patients undergoing primary chemotherapy, as a significant proportion (40%) are left with histological abnormalities that predispose to subsequent relapse. Persistence of invasive NSGCT at the site of the primary tumour after chemotherapy is associated with persistence of invasive disease at other metastatic sites and is a poor prognostic finding.

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Published date: 2002

Identifiers

Local EPrints ID: 26321
URI: http://eprints.soton.ac.uk/id/eprint/26321
ISSN: 1464-4096
PURE UUID: 21116643-41f6-420a-a0e4-b6eeeecf19d9

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Date deposited: 20 Apr 2006
Last modified: 15 Jul 2019 19:14

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