Management of residual non-retroperitoneal disease following chemotherapy for germ cell tumor

Over the past 20 years, it is estimated that approximately 195,969 patients were diagnosed with testicular cancer in the United States and that 22,144 of those patients had non-retroperitoneal (non-RP) metastases at the time of diagnosis. Although most patients with testicular cancer can be cured with platinum-based systemic chemotherapy, 35% of patients with Stage III/IV disease will have residual non-RP masses after treatment. The management paradigms for residual, non-RP disease following chemotherapy for nonseminomatous germ cell tumor are influenced by the site of metastases as well as whether there is concordant histology between the testicle and the metastatic site. Although retroperitoneal lymph node dissection findings such as the presence of fibrosis only are helpful indicators of concordant histology, no set of criteria provides a perfect prediction such that the risk of residual teratoma or viable GCT outside the retroperitoneum is eliminated. This acknowledgement, in conjunction with the long-term survival data favoring resection, establishes that surgical resection remains an important part of the management of patients with non-RP residual masses.