664 OUTCOME OF VIABLE SEMINOMA AT POSTCHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease I1 Apr 2012664 OUTCOME OF VIABLE SEMINOMA AT POSTCHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION Kevin Rice, Stephen Beck, Richard Bihrle, Einhorn Lawrence, and Richard Foster Kevin RiceKevin Rice Indianapolis, IN More articles by this author , Stephen BeckStephen Beck Indianapolis, IN More articles by this author , Richard BihrleRichard Bihrle Indianapolis, IN More articles by this author , Einhorn LawrenceEinhorn Lawrence Indianapolis, IN More articles by this author , and Richard FosterRichard Foster Indianapolis, IN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.745AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The presence of viable seminoma at postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) is rare due to the chemosensitivity of this germ cell tumor. Thus, behavior of residual seminoma has not been well established. At Indiana University, PC-RPLND is performed only on the rare seminoma patient that demonstrates radiographic or serologic evidence of progression after chemotherapy. The purpose of this study is to define the clinicopathologic behavior of viable seminoma at PC-RPLND. METHODS The Indiana University Testis Cancer Database was queried from 1988 to 2011 to identify all patients with primary testicular or extragonadal pure seminoma and demonstrating pure seminoma at PC-RPLND. Clinicopathologic and treatment characteristics were reviewed. Survival analysis was performed. RESULTS 37 patients met the inclusion criteria. Mean patient age at diagnosis was 37.4 years. Three, 20, and 13 patients presented initially with clinical stage I, II, and III disease, respectively. Staging information was unavailable in 1 patient. All but 1 patient had good risk disease. Thirty-one patients were managed primarily with cisplatin-based chemotherapy. Three patients each were primarily managed with surveillance and external beam radiation, respectively. Fifteen patients received second line chemotherapy, 1 of whom subsequently received high-dose chemotherapy (HDCT) prior to PC-RPLND. The decision to proceed to surgical resection was based on radiologic or serologic evidence of progression after chemotherapy. The mean tumor size at PC-RPLND was 5.7 cm. Seven patients had undergone previous RPLND. Twelve patients had elevated human chorionic gonadotropin at the time of surgery. Postoperative chemotherapy was administered in 18 patients. Median follow-up was 65 months. At last follow-up, 16 patients (43.2%) had died of disease and 20 patients (56.8%) had no evidence of disease (NED), including 1 patient who died of an unrelated cause at 93 months. The mean time from PC-RPLND to death was 6.9 months (3-16 months). Second line chemotherapy was the only variable that predicted cancer specific death on both univariate (p = 0.013) and multivariate (p = 0.012) analyses. CONCLUSIONS In this heavily pretreated patient population, 56.8% of patients with viable seminoma at PC-RPLND were NED at last follow-up. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e271 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Rice Indianapolis, IN More articles by this author Stephen Beck Indianapolis, IN More articles by this author Richard Bihrle Indianapolis, IN More articles by this author Einhorn Lawrence Indianapolis, IN More articles by this author Richard Foster Indianapolis, IN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...