Post chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for metastatic pure seminoma
(2024) In Journal of Clinical Oncology 42(16).- Abstract
Background: Surgical resection of post-chemotherapy residual masses for metastatic seminoma is discussed controversially with regard to oncological and functional outcome. Furthermore, the role of FDG-PET/CT to detect vital seminoma is still unclear. It is the aim of this study is to report the outcomes of patients with pure seminoma who underwent PC-RPLND. Methods: In this retrospective multi-institutional study, pure seminoma patients whounderwent PC-RPLND for marker negative, FDG-PET/CT positive residual masses. 3cm or marker negative retroperitoneal relapse following first line chemotherapy between 2000 and 2023 were included. Patients with residual masses and negative FDG-PET/CT, inadequate systemic chemotherapy, insufficient... (More)
Background: Surgical resection of post-chemotherapy residual masses for metastatic seminoma is discussed controversially with regard to oncological and functional outcome. Furthermore, the role of FDG-PET/CT to detect vital seminoma is still unclear. It is the aim of this study is to report the outcomes of patients with pure seminoma who underwent PC-RPLND. Methods: In this retrospective multi-institutional study, pure seminoma patients whounderwent PC-RPLND for marker negative, FDG-PET/CT positive residual masses. 3cm or marker negative retroperitoneal relapse following first line chemotherapy between 2000 and 2023 were included. Patients with residual masses and negative FDG-PET/CT, inadequate systemic chemotherapy, insufficient clinical data, positive markers, or with residual or relapsing masses following salvage chemotherapy were excluded. Perioperative and long-term outcomes were reviewed. Results: 109 patients were included. All patients received first-line cisplatin-based chemotherapy. Clinical features of the patients are presented in the table. 92.6% of PC-RPLNDs were performed via an open transperitoneal approach. 61 (55.9%) and 48 (44.1%) pts underwent unilateral and a full bilateral resection, resp. Adjunctive surgery was performed in 46 (42%) pts, the most common of which were ureteral resection/repair in 16 (15%) pts, and vascular resection/repair in 14 (13%) pts. Median (IQR) blood loss and length of hospital stay were 550 (300 – 5800) mL and 4 (2 – 18) days, resp. Clavien - Dindo complications $ 3a developed in 11 (10.1%) pts. Final pathology revealed necrosis/fibrosis in 75 (69%) and seminoma in 34 (31%). FDG-PET/CT for residual masses. 3cm showed a positive predictive value of only 20%. Except for marker negative progression (p,0.001), no reliable clinicopathologic parameters were identified to predict presence of viable seminoma. With a median (IQR) follow-up of 56 (2 – 164) months, 15 (14%) patients relapsed (12 with lymph node, 3 with visceral/skeletal metastases). 3 (3%) patients died of disease. Conclusions: One third of patients with progressive or. 3cm FDG-PET-CT positive residual retroperitoneal masses following first-line chemotherapy for metastatic seminoma may have viable tumor. FDG-PET/CT has a poor positive predictive value and might be omitted as staging procedure. In selected cases, PC-RPLND may be a valuable option if performed in high-volume centers with expertise in testicular cancer management. Research Sponsor: None.
(Less)
- author
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of Clinical Oncology
- volume
- 42
- issue
- 16
- article number
- 5037
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- scopus:105023651210
- ISSN
- 0732-183X
- DOI
- 10.1200/JCO.2024.42.16_suppl.5037
- language
- English
- LU publication?
- yes
- id
- a71ade3d-2965-4ede-8d16-206a85290ccb
- date added to LUP
- 2026-02-10 10:19:31
- date last changed
- 2026-02-10 10:19:31
@article{a71ade3d-2965-4ede-8d16-206a85290ccb,
abstract = {{<p>Background: Surgical resection of post-chemotherapy residual masses for metastatic seminoma is discussed controversially with regard to oncological and functional outcome. Furthermore, the role of FDG-PET/CT to detect vital seminoma is still unclear. It is the aim of this study is to report the outcomes of patients with pure seminoma who underwent PC-RPLND. Methods: In this retrospective multi-institutional study, pure seminoma patients whounderwent PC-RPLND for marker negative, FDG-PET/CT positive residual masses. 3cm or marker negative retroperitoneal relapse following first line chemotherapy between 2000 and 2023 were included. Patients with residual masses and negative FDG-PET/CT, inadequate systemic chemotherapy, insufficient clinical data, positive markers, or with residual or relapsing masses following salvage chemotherapy were excluded. Perioperative and long-term outcomes were reviewed. Results: 109 patients were included. All patients received first-line cisplatin-based chemotherapy. Clinical features of the patients are presented in the table. 92.6% of PC-RPLNDs were performed via an open transperitoneal approach. 61 (55.9%) and 48 (44.1%) pts underwent unilateral and a full bilateral resection, resp. Adjunctive surgery was performed in 46 (42%) pts, the most common of which were ureteral resection/repair in 16 (15%) pts, and vascular resection/repair in 14 (13%) pts. Median (IQR) blood loss and length of hospital stay were 550 (300 – 5800) mL and 4 (2 – 18) days, resp. Clavien - Dindo complications $ 3a developed in 11 (10.1%) pts. Final pathology revealed necrosis/fibrosis in 75 (69%) and seminoma in 34 (31%). FDG-PET/CT for residual masses. 3cm showed a positive predictive value of only 20%. Except for marker negative progression (p,0.001), no reliable clinicopathologic parameters were identified to predict presence of viable seminoma. With a median (IQR) follow-up of 56 (2 – 164) months, 15 (14%) patients relapsed (12 with lymph node, 3 with visceral/skeletal metastases). 3 (3%) patients died of disease. Conclusions: One third of patients with progressive or. 3cm FDG-PET-CT positive residual retroperitoneal masses following first-line chemotherapy for metastatic seminoma may have viable tumor. FDG-PET/CT has a poor positive predictive value and might be omitted as staging procedure. In selected cases, PC-RPLND may be a valuable option if performed in high-volume centers with expertise in testicular cancer management. Research Sponsor: None.</p>}},
author = {{Heidenreich, Axel and Daneshmand, Siamak and Che, Yu and Pfister, David A. and Paffenholz, Pia and Ghoreifi, Alireza and Zschaebitz, Stefanie and Hentrich, Marcus and Thy, Sophia and Albers, Peter and Cary, Clint and Gerdtsson, Axel and Kjellman, Anders and Negaard, Helene F.S.}},
issn = {{0732-183X}},
language = {{eng}},
number = {{16}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Journal of Clinical Oncology}},
title = {{Post chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for metastatic pure seminoma}},
url = {{http://dx.doi.org/10.1200/JCO.2024.42.16_suppl.5037}},
doi = {{10.1200/JCO.2024.42.16_suppl.5037}},
volume = {{42}},
year = {{2024}},
}