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    Histological outcome of delayed orchidectomy after primary chemotherapy for metastatic germ cell tumour of the testis.

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    Authors
    Ramani, Vijay A C
    Grey, Benjamin R
    Addla, Sanjai K
    Dunham, Mark P
    Sangar, Vijay K
    Clarke, Noel W
    Affiliation
    Christie Hospital NHS Foundation Trust, Manchester, UK.
    Issue Date
    2008-04
    
    Metadata
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    Abstract
    AIMS: To identify the incidence of viable local tumour in the testis of patients undergoing delayed orchidectomy after initial presentation with advanced germ cell tumour (GCT) treated by primary chemotherapy. PATIENTS AND METHODS: Thirty-three patients presenting with advanced metastatic GCT were reviewed. The median age at presentation was 34 years. All received chemotherapy without previous orchidectomy. The decision to initiate chemotherapy without orchidectomy was based on a heavy tumour load and the patient's condition at initial presentation. A histological diagnosis was available from a biopsy of metastases in 23 patients; treatment in the remaining 10 patients was initiated after diagnosis based on a combination of elevated serum tumour markers, testicular findings and the presence of a retroperitoneal mass. RESULTS: Seminomatous GCT (SGCT) was diagnosed in 13 patients, non-seminomatous GCT (NSGCT) in 17 patients and mixed GCT (MGCT) in the remaining three patients. Bleomycin/etoposide/cisplatin-based chemotherapy was the principle regimen. After initial chemotherapy, all patients with pure SGCT had only scar tissue in the orchidectomy specimen, with no residual tumour. Nine of 17 patients (52.9%) with NSGCT had viable tumour remaining in the orchidectomy specimen. All three cases of MGCT had persistent viable invasive seminoma. Twenty-seven patients (81.8%) were recurrence free and alive after a median of 49 months of follow-up. CONCLUSIONS: Thirty-six per cent of patients had residual tumour locally in the testis after primary chemotherapy for metastatic GCT of the testis. However, in the cases with pure seminomatous disease, there was no residual tumour present. It may not be necessary to undertake delayed orchidectomy in these patients.
    Citation
    Histological outcome of delayed orchidectomy after primary chemotherapy for metastatic germ cell tumour of the testis. 2008, 20 (3):247-52 Clin Oncol
    Journal
    Clinical Oncology
    URI
    http://hdl.handle.net/10541/66154
    DOI
    10.1016/j.clon.2007.11.009
    PubMed ID
    18093814
    Type
    Article
    Language
    en
    ISSN
    0936-6555
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.clon.2007.11.009
    Scopus Count
    Collections
    All Christie Publications
    Urological Oncology

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