Ravi R, Ong J, Oliver RT, Badenoch DF, Fowler CG, Hendry WF. The management of residual masses after chemotherapy in metastatic seminoma.
BJU Int 1999;
83:649-53. [PMID:
10233573 DOI:
10.1046/j.1464-410x.1999.00974.x]
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Abstract
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.
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