Decision analysis for avoiding postchemotherapy surgery in patients with disseminated nonseminomatous germ cell tumors

D. J. Debono, D. K. Heilman, Lawrence Einhorn, J. P. Donohue

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Abstract

Purpose: This retrospective study was undertaken to assess the outcome of patients with disseminated non-seminomatous germ cell tumor (NSGCT) managed under a postchemotherapy strategy developed at Indiana University. Patients and Methods: This is a retrospective analysis of 295 consecutive patients with disseminated NSGCT treated with primary chemotherapy at Indiana University from 1987 to 1994. The patients were placed into five groups based on response to primary chemotherapy and the presence or absence of teratoma in the primary tumor. The 295 patients were divided as follows: group A (complete remission [CR]) n = 78; group B (unresectable), n = 50; group C (serologic CR, teratoma-positive primary tumor, resectable partial remission [PR]), n = 90; group D (serologic CR, teratoma-negative primary tumor, < 90% radiographic PR), n = 50; and group E (serologic CR, teratoma-negative primary tumor, ≤ 90% radiographic PR), n = 27. Groups A, B, and E patients were routinely observed after chemotherapy, whereas groups C and D patients were routinely taken to postchemotherapy surgery. Results: The percent of patients who continuously had no evidence of disease (NED) were as follows: group A, 92%; group B, 40%; group C, 87%; group D, 86%; and group E, 74%. In assessing group A patients, the bulk of retroperitoneal disease at presentation had no influence on ultimate outcome. Conclusion: Patients with NSGCT who achieve a serologic and radiographic CR with primary chemotherapy (group A) can be safely observed without surgical intervention, regardless of initial tumor bulk. Patients with a teratoma-negative primary tumor who achieve a serologic CR and a ≤ 90% radiographic remission and are followed- up without surgical resection (group E) are at an increased risk of relapsed NSGCT. Decisions about postchemotherapy resection in this group remain complicated and controversial. Options include observation with serial radiologic evaluation or surgical resection of persistent mass or masses.

Original languageEnglish
Pages (from-to)1455-1464
Number of pages10
JournalJournal of Clinical Oncology
Volume15
Issue number4
StatePublished - Apr 1997

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Decision Support Techniques
Teratoma
Drug Therapy
Neoplasms
Nonseminomatous germ cell tumor
Retrospective Studies
Observation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Decision analysis for avoiding postchemotherapy surgery in patients with disseminated nonseminomatous germ cell tumors. / Debono, D. J.; Heilman, D. K.; Einhorn, Lawrence; Donohue, J. P.

In: Journal of Clinical Oncology, Vol. 15, No. 4, 04.1997, p. 1455-1464.

Research output: Contribution to journalArticle

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title = "Decision analysis for avoiding postchemotherapy surgery in patients with disseminated nonseminomatous germ cell tumors",
abstract = "Purpose: This retrospective study was undertaken to assess the outcome of patients with disseminated non-seminomatous germ cell tumor (NSGCT) managed under a postchemotherapy strategy developed at Indiana University. Patients and Methods: This is a retrospective analysis of 295 consecutive patients with disseminated NSGCT treated with primary chemotherapy at Indiana University from 1987 to 1994. The patients were placed into five groups based on response to primary chemotherapy and the presence or absence of teratoma in the primary tumor. The 295 patients were divided as follows: group A (complete remission [CR]) n = 78; group B (unresectable), n = 50; group C (serologic CR, teratoma-positive primary tumor, resectable partial remission [PR]), n = 90; group D (serologic CR, teratoma-negative primary tumor, < 90{\%} radiographic PR), n = 50; and group E (serologic CR, teratoma-negative primary tumor, ≤ 90{\%} radiographic PR), n = 27. Groups A, B, and E patients were routinely observed after chemotherapy, whereas groups C and D patients were routinely taken to postchemotherapy surgery. Results: The percent of patients who continuously had no evidence of disease (NED) were as follows: group A, 92{\%}; group B, 40{\%}; group C, 87{\%}; group D, 86{\%}; and group E, 74{\%}. In assessing group A patients, the bulk of retroperitoneal disease at presentation had no influence on ultimate outcome. Conclusion: Patients with NSGCT who achieve a serologic and radiographic CR with primary chemotherapy (group A) can be safely observed without surgical intervention, regardless of initial tumor bulk. Patients with a teratoma-negative primary tumor who achieve a serologic CR and a ≤ 90{\%} radiographic remission and are followed- up without surgical resection (group E) are at an increased risk of relapsed NSGCT. Decisions about postchemotherapy resection in this group remain complicated and controversial. Options include observation with serial radiologic evaluation or surgical resection of persistent mass or masses.",
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N2 - Purpose: This retrospective study was undertaken to assess the outcome of patients with disseminated non-seminomatous germ cell tumor (NSGCT) managed under a postchemotherapy strategy developed at Indiana University. Patients and Methods: This is a retrospective analysis of 295 consecutive patients with disseminated NSGCT treated with primary chemotherapy at Indiana University from 1987 to 1994. The patients were placed into five groups based on response to primary chemotherapy and the presence or absence of teratoma in the primary tumor. The 295 patients were divided as follows: group A (complete remission [CR]) n = 78; group B (unresectable), n = 50; group C (serologic CR, teratoma-positive primary tumor, resectable partial remission [PR]), n = 90; group D (serologic CR, teratoma-negative primary tumor, < 90% radiographic PR), n = 50; and group E (serologic CR, teratoma-negative primary tumor, ≤ 90% radiographic PR), n = 27. Groups A, B, and E patients were routinely observed after chemotherapy, whereas groups C and D patients were routinely taken to postchemotherapy surgery. Results: The percent of patients who continuously had no evidence of disease (NED) were as follows: group A, 92%; group B, 40%; group C, 87%; group D, 86%; and group E, 74%. In assessing group A patients, the bulk of retroperitoneal disease at presentation had no influence on ultimate outcome. Conclusion: Patients with NSGCT who achieve a serologic and radiographic CR with primary chemotherapy (group A) can be safely observed without surgical intervention, regardless of initial tumor bulk. Patients with a teratoma-negative primary tumor who achieve a serologic CR and a ≤ 90% radiographic remission and are followed- up without surgical resection (group E) are at an increased risk of relapsed NSGCT. Decisions about postchemotherapy resection in this group remain complicated and controversial. Options include observation with serial radiologic evaluation or surgical resection of persistent mass or masses.

AB - Purpose: This retrospective study was undertaken to assess the outcome of patients with disseminated non-seminomatous germ cell tumor (NSGCT) managed under a postchemotherapy strategy developed at Indiana University. Patients and Methods: This is a retrospective analysis of 295 consecutive patients with disseminated NSGCT treated with primary chemotherapy at Indiana University from 1987 to 1994. The patients were placed into five groups based on response to primary chemotherapy and the presence or absence of teratoma in the primary tumor. The 295 patients were divided as follows: group A (complete remission [CR]) n = 78; group B (unresectable), n = 50; group C (serologic CR, teratoma-positive primary tumor, resectable partial remission [PR]), n = 90; group D (serologic CR, teratoma-negative primary tumor, < 90% radiographic PR), n = 50; and group E (serologic CR, teratoma-negative primary tumor, ≤ 90% radiographic PR), n = 27. Groups A, B, and E patients were routinely observed after chemotherapy, whereas groups C and D patients were routinely taken to postchemotherapy surgery. Results: The percent of patients who continuously had no evidence of disease (NED) were as follows: group A, 92%; group B, 40%; group C, 87%; group D, 86%; and group E, 74%. In assessing group A patients, the bulk of retroperitoneal disease at presentation had no influence on ultimate outcome. Conclusion: Patients with NSGCT who achieve a serologic and radiographic CR with primary chemotherapy (group A) can be safely observed without surgical intervention, regardless of initial tumor bulk. Patients with a teratoma-negative primary tumor who achieve a serologic CR and a ≤ 90% radiographic remission and are followed- up without surgical resection (group E) are at an increased risk of relapsed NSGCT. Decisions about postchemotherapy resection in this group remain complicated and controversial. Options include observation with serial radiologic evaluation or surgical resection of persistent mass or masses.

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