Post Chemotherapy RPLND in Patients with Elevated Markers: Current Concepts and Clinical Outcome

Stephen D.W. Beck, Richard S. Foster, Richard Bihrle, Lawrence H. Einhorn, John P. Donohue

Research output: Contribution to journalReview article

12 Scopus citations

Abstract

Elevated serum tumor markers after cisplatin-based chemotherapy usually contraindicate surgery because of the presence of active germ-cell elements; however, some patients have undergone PCRPLND with curative intent. We evaluated the role of surgery to resect retroperitoneal-only marker positive tumor. Residual germ-cell cancer was identified in 50% of patients with elevated tumor markers with one third alive at 5 years; 5-year survival with residual teratoma or necrosis was 77.5% and 85.7%, respectively. Predictors of retroperitoneal teratoma or fibrosis included declining tumor makers at surgery, βHCG < 100, and first-line chemotherapy. Predictors of death included rising preoperative βHCG, elevated AFP, redo RPLND, and active germ-cell cancer in the resected specimen. Select patients with elevated tumor markers after chemotherapy are cured with surgery.

Original languageEnglish (US)
Pages (from-to)219-225
Number of pages7
JournalUrologic Clinics of North America
Volume34
Issue number2
DOIs
StatePublished - May 1 2007

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ASJC Scopus subject areas

  • Urology

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