Presentation Authors: Gregory Nason*, Aaron Hansen, Philippe Bedard, Padraig Warde, Peter Chung, Michael Jewett, Lynn Anson-Cartwright, Joan Sweet, Martin O'Malley, Robert Hamilton, Toronto, Canada
Introduction: The management of small volume (â‰¤ 1cm) residual disease post chemotherapy for non-seminomatous germ cell testicular cancer (NSGCT) is controversial. Traditionally a post chemotherapy retroperitoneal lymph node dissection (pcRPLND) has been advocated as >45% will harbor mature teratoma and 10% viable cancer. However pcRPLND is not without morbidity. The aim of this study is to report the experience of surveillance for â‰¤1cm post chemotherapy residual masses.
Methods: A retrospective review was performed of a prospectively maintained multidisciplinary testicular cancer database at the Princess Margaret Cancer Center. All patients who underwent primary chemotherapy for NSGCT were identified between 1981 and 2018. Patients were classified as having a complete response if there was â‰¤1cm residual mass noted on cross sectional imaging with normal serum tumor markers following chemotherapy.
Results: During the study period, 169 men had a complete response (â‰¤1cm residual mass) following chemotherapy. The mean age at initiation of chemotherapy was 29.4 years (Range 15-69 years). The mean follow up was 99.2 months (Range 3- 350 months). The AJCC stage at diagnosis included 2A (89- 52.7%), 2C (4- 2.4%), 3A (37- 21.9%), 3b (33- 19.5%), 3C (6- 3.5%). The IGCCCG risk group classifications were- 132 (78.1%) good risk, 31 (18.3%) intermediate risk, 6 (3.5%) poor risk.Of these, 156 men (91.2%) never relapsed and remain disease free. 13 men (7.7%) relapsed after a mean of 72 months (Range 3-339). 8 of these underwent a post chemotherapy RPLND- all are free of disease and alive. The histology of the pcRPLND in these patients was mature teratoma in 6, necrosis in 1 and viable tumor in 1. 5 patients developed disseminated metastases and were treated with salvage chemotherapy. 2 of these have died- two with thoracic metastases.
Conclusions: Surveillance is a safe strategy for men with residual (â‰¤1cm) masses post chemotherapy and avoids the morbidity associated with pcRPLND. pcRPLND can still be used effectively as a salvage strategy in men who progress.