Marker-positive patients with germ-cell tumors: when is residual tumor resection useful?

Summary We analyzed 33 patients with disseminated germ cell tumors (GCT) who underwent residual tumor resection (RTR) during the period from 1991–1997. The patients were markerpositive prior to surgery were analyzed. The histopathological examination of the resected masses, the marker dynamics and the relapse-free respectively the progressionfree survival, were evaluated. The status differed at primary diagnosis: minimal disease n = 1, moderate disease n = 15, advanced disease n = 17. The patients received at average 8,5 cisplatin-containing cycles of polychemotherapy. Only 11 patients underwent surgery after first-line-chemotherapy. The remaining received second- or third-line-chemotherapy prior to surgery. In 12 of 31 evaluable patients, a durable CR was achieved. The median follow-up for this group is 30 months (2–58 months). The histopathologic examination of the resected specimen and the tumor marker level prior to RTR do not permit determination of prognostic outcome. After operation 44 % of the AFP-positive and 30 % of the β -HCG-positive patients had a durable remission. If tumor marker levels at time of RTR are within normal range, disease-free survival is 72 %; in case of elevated markers 39 % will survive. If intensive chemotherapy fails to normalize markers, RTR remains the only option to change the fatal course of the disease.