Resection of residual pulmonary masses after chemotherapy in patients with metastatic non-seminomatous germ cell tumours.

BACKGROUND: Resection of residual post-chemotherapy pulmonary masses in patients with non-seminomatous germ cell tumours gives therapeutic benefit and prognostic information. AIM: This study was undertaken to review the experience of this intervention in a single teaching hospital. METHODS: The Germ Cell Database of the Sydney Cancer Centre was searched for all patients who had undergone excision of pulmonary metastases. These patient records were subsequently reviewed. RESULTS: Between 1976 and 1999, 15 patients underwent a combined total of 19 thoracotomies for resection of residual tumour mass after cisplatin-based chemotherapy. The primary tumour histology included mature teratoma in 47% (7 of 15) of patients. Prior to chemotherapy, 73% (11 of 15) of patients had elevated serum levels of alpha-fetoprotein (median 180 ng/mL) and 60% (9 of 15) of patients had elevated beta-human chorionic gonadotropin (median 672 IU/L). The median length of hospital stay related to thoracotomy was 7 days. There were two surgical complications, a prolonged air leak and a residual pleural effusion. Pathology of residual pulmonary masses revealed necrosis alone in 37% (7 of 19) of procedures, mature teratoma alone in 32% (6 of 19) of procedures and viable tumour in 32% (6 of 19) of procedures. Of those with viable tumour, three achieved long-term complete response (CR), two died of progressive disease (PD) and one is alive with PD. Of those with teratoma, two achieved CR and one relapsed. The long-term CR rate was 80% (12 of 15 patients). The median follow up was 10 years (range 0.75-17.5 years). Four patients died, two of PD and two of cardiovascular disease while in CR. CONCLUSION: At this institution, thoracotomy for residual pulmonary masses was well tolerated, with a high cure rate.